MEDICARE: RAE ANNE NATHANSON OTD, 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	022812	NY

General Provider Information

NPI Number	:	1700354545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAE ANNE NATHANSON OTD, OTR/L

Provider Business Mailing Address
First Line	:	750 LIDO BLVD APT 17A
Second Line	:
City	:	LIDO BEACH
State	:	NY
Zip	:	11561-5200
Country	:	US
Telephone Number	:	917-685-9914
Fax Number	:

Provider Business Practice Location Address
First Line	:	1723 E 12TH ST STE 5L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1071
Country	:	US
Telephone Number	:	718-339-4000
Fax Number	:

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

Provider Enumeration Date	:	11/09/2018
Last Update Date	:	11/09/2018

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