MEDICARE: THERAPY CENTRO, OT, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1801041165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY CENTRO, OT, PC

Provider Business Mailing Address
First Line	:	4632 SPRINGFIELD BLVD
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-3517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4632 SPRINGFIELD BLVD
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-3517
Country	:	US
Telephone Number	:	917-553-4824
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MS. ANITA LIU-CHEN
Credential	:	OTR/L
Telephone Number	:	917-553-4824

Provider Enumeration Date	:	11/28/2008
Last Update Date	:	11/28/2008

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