MEDICARE: MRS. LOURDES VICTORIA COMPARETTO OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	015565-1	NY

General Provider Information

NPI Number	:	1225262363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOURDES VICTORIA COMPARETTO OTR/L

Provider Business Mailing Address
First Line	:	3146 35TH ST APT 1R
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-1543
Country	:	US
Telephone Number	:	718-288-4023
Fax Number	:	718-267-2119

Provider Business Practice Location Address
First Line	:	3636 33RD ST STE 500
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-2329
Country	:	US
Telephone Number	:	212-529-9780
Fax Number	:	646-218-3768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2009
Last Update Date	:	05/04/2009

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