MEDICARE: GINA DECESARE

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	006757	NY

General Provider Information

NPI Number	:	1942446794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA DECESARE

Provider Business Mailing Address
First Line	:	13 BRYANT CRES
Second Line	:	1L
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-2738
Country	:	US
Telephone Number	:	914-263-1713
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 BRYANT CRES
Second Line	:	1L
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-2738
Country	:	US
Telephone Number	:	914-263-1713
Fax Number	:

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

Provider Enumeration Date	:	12/29/2008
Last Update Date	:	12/29/2008

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