MEDICARE: MR. WILLIAM DANIEL DEASE III 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	007477	NY
2	225XE0001X	Environmental Modification Occupational Therapist	007477	NY
3	225XE1200X	Ergonomics Occupational Therapist	007477	NY
4	225XF0002X	Feeding, Eating & Swallowing Occupational Therapist	007477	NY
5	225XG0600X	Gerontology Occupational Therapist	007477	NY
6	225XN1300X	Neurorehabilitation Occupational Therapist	007477	NY
7	225XP0019X	Physical Rehabilitation Occupational Therapist	007477	NY
8	225XP0200X	Pediatric Occupational Therapist	007477	NY
9	225XR0403X	Driving and Community Mobility Occupational Therapist	007477	NY

General Provider Information

NPI Number	:	1518285287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM DANIEL DEASE III OTR

Provider Business Mailing Address
First Line	:	6800 JERICHO TPKE
Second Line	:	SUITE 120W
City	:	SYOSSET
State	:	NY
Zip	:	11791-4436
Country	:	US
Telephone Number	:	631-600-3029
Fax Number	:	800-783-5909

Provider Business Practice Location Address
First Line	:	6800 JERICHO TPKE
Second Line	:	SUITE 120W
City	:	SYOSSET
State	:	NY
Zip	:	11791-4436
Country	:	US
Telephone Number	:	631-600-3029
Fax Number	:	800-783-5909

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

Provider Enumeration Date	:	05/05/2010
Last Update Date	:	02/28/2017

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