MEDICARE: PROACTIVE OCCUPATIONAL THERAPY PC

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	016202	NY

General Provider Information

NPI Number	:	1710383930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROACTIVE OCCUPATIONAL THERAPY PC

Provider Business Mailing Address
First Line	:	6202 20TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3023
Country	:	US
Telephone Number	:	917-544-3060
Fax Number	:	718-259-7225

Provider Business Practice Location Address
First Line	:	6202 20TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3023
Country	:	US
Telephone Number	:	917-544-3060
Fax Number	:	718-259-7225

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ISRAEL CYWIAK
Credential	:	OTR/L
Telephone Number	:	917-544-3060

Provider Enumeration Date	:	11/16/2014
Last Update Date	:	01/15/2015

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