MEDICARE: MS. ROSE SOLOMON OTR

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	506964	NY
2	225XP0200X	Pediatric Occupational Therapist	506964	NY

General Provider Information

NPI Number	:	1386958486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSE SOLOMON OTR

Provider Business Mailing Address
First Line	:	647 E 14TH ST
Second Line	:	10A
City	:	NEW YORK
State	:	NY
Zip	:	10009-3101
Country	:	US
Telephone Number	:	917-558-1823
Fax Number	:

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

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

Provider Enumeration Date	:	07/30/2010
Last Update Date	:	07/30/2010

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