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NPI Code Detail

MEDICARE: GISELLE LUISTRO BOTE

MEDICARE: GISELLE LUISTRO BOTE
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
1225XP0200XPediatric Occupational Therapist010182-1NY

General Provider Information

NPI Number : 1811014152
Entity Type Code : Individual
Provider Name (Legal Business Name) : GISELLE LUISTRO BOTE
Provider Business Mailing Address
First Line : 1310 PURITAN AVE
Second Line :
City : BRONX
State : NY
Zip : 10461-5923
Country : US
Telephone Number : 347-293-7186
Fax Number :
Provider Business Practice Location Address
First Line : 1310 PURITAN AVE
Second Line :
City : BRONX
State : NY
Zip : 10461-5923
Country : US
Telephone Number : 347-293-7186
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 07/08/2007

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Directions to “ GISELLE LUISTRO BOTE ” Practice Location

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