MEDICARE: NEUROADEPT OCCUPATIONAL THERAPIST

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	008641-1	NY

General Provider Information

NPI Number	:	1548635238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROADEPT OCCUPATIONAL THERAPIST

Provider Business Mailing Address
First Line	:	168 WILSON RD
Second Line	:
City	:	SPARROW BUSH
State	:	NY
Zip	:	12780-5440
Country	:	US
Telephone Number	:	845-313-2382
Fax Number	:	845-810-7013

Provider Business Practice Location Address
First Line	:	168 WILSON RD
Second Line	:
City	:	SPARROW BUSH
State	:	NY
Zip	:	12780-5440
Country	:	US
Telephone Number	:	845-313-2382
Fax Number	:	845-810-7013

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. WILLIAM P KOWAL
Credential	:	OTR/L
Telephone Number	:	845-313-2382

Provider Enumeration Date	:	12/06/2015
Last Update Date	:	12/06/2015

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