MEDICARE: SANDRA C PRENTICE

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	P117990	NY

General Provider Information

NPI Number	:	1336862655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA C PRENTICE

Provider Business Mailing Address
First Line	:	11127 167TH ST # 11434
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11433-3911
Country	:	US
Telephone Number	:	347-475-7085
Fax Number	:

Provider Business Practice Location Address
First Line	:	11127 167TH ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11433-3911
Country	:	US
Telephone Number	:	347-475-7085
Fax Number	:

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

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	09/21/2022

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Directions to “ SANDRA C PRENTICE ” Practice Location

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