MEDICARE: AVIRA OT PT SPEECH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225XG0600X	Gerontology Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	2251G0304X	Geriatric Physical Therapist

General Provider Information

NPI Number	:	1891639530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVIRA OT PT SPEECH PLLC

Provider Business Mailing Address
First Line	:	36 GARDEN CIR
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-4803
Country	:	US
Telephone Number	:	914-712-5146
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 GARDEN CIR
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-4803
Country	:	US
Telephone Number	:	914-712-5146
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DAISY STEPHEN
Credential	:	STEPHEN
Telephone Number	:	914-837-6538

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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