MEDICARE: MS. CANISIA PALTON 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	0082121	NY

General Provider Information

NPI Number	:	1407090277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CANISIA PALTON OTR/L

Provider Business Mailing Address
First Line	:	1040 E 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4243
Country	:	US
Telephone Number	:
Fax Number	:	718-209-6399

Provider Business Practice Location Address
First Line	:	1040 E 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4243
Country	:	US
Telephone Number	:	718-209-6399
Fax Number	:	718-209-6399

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

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	04/23/2009

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