MEDICARE: MRS. SUZIE DORSAINVIL OCCUP. 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	225XG0600X	Gerontology Occupational Therapist	004989	NY
2	225XP0019X	Physical Rehabilitation Occupational Therapist	004989	NY
3	225XP0200X	Pediatric Occupational Therapist	004989	NY

General Provider Information

NPI Number	:	1710130869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZIE DORSAINVIL OCCUP. THERAPIST

Provider Business Mailing Address
First Line	:	39 MOLYNEAUX RD
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-1925
Country	:	US
Telephone Number	:	516-561-9522
Fax Number	:	516-561-9522

Provider Business Practice Location Address
First Line	:	39 MOLYNEAUX RD
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-1925
Country	:	US
Telephone Number	:	516-561-9522
Fax Number	:	516-561-9522

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

Provider Enumeration Date	:	11/01/2008
Last Update Date	:	11/01/2008

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