MEDICARE: WILSON JOY DANIEL 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	013405	NY

General Provider Information

NPI Number	:	1245349513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILSON JOY DANIEL OTR/L

Provider Business Mailing Address
First Line	:	202 HEATHCOTE RD
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-2006
Country	:	US
Telephone Number	:	516-326-0874
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 HILLSIDE AVE
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2603
Country	:	US
Telephone Number	:	516-616-0942
Fax Number	:	516-616-0943

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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