MEDICARE: MR. DAVID CARROCA 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	008810	NY

General Provider Information

NPI Number	:	1346437621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID CARROCA OTR/L

Provider Business Mailing Address
First Line	:	136 FORT GREENE PL
Second Line	:	SUITE B
City	:	BROOKLYN
State	:	NY
Zip	:	11217-1419
Country	:	US
Telephone Number	:	347-853-2906
Fax Number	:	718-858-5953

Provider Business Practice Location Address
First Line	:	136 FORT GREENE PL
Second Line	:	SUITE B
City	:	BROOKLYN
State	:	NY
Zip	:	11217-1419
Country	:	US
Telephone Number	:	347-853-2906
Fax Number	:	718-858-5953

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

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	10/01/2007

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