MEDICARE: SPOTS

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

General Provider Information

NPI Number	:	1639578248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPOTS

Provider Business Mailing Address
First Line	:	450 E 146TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-4136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 E 146TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-4136
Country	:	US
Telephone Number	:	646-420-8842
Fax Number	:

Authorized Official
Title or Position	:	FOUNDING PARTNER OF ORGANIZATION
Name	:	PRUDENCE HEISLER
Credential	:	OTR/L
Telephone Number	:	212-473-0011

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	08/19/2014

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Directions to “SPOTS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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