MEDICARE: BETH COHEN OTR

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	225XP0200X	Pediatric Occupational Therapist	004019-1	NY

General Provider Information

NPI Number	:	1730498544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH COHEN OTR

Provider Business Mailing Address
First Line	:	18 INGOLD DR
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-7804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 INGOLD DR
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-7804
Country	:	US
Telephone Number	:	631-943-1419
Fax Number	:

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

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	09/28/2010

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Directions to “ BETH COHEN OTR” Practice Location

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