MEDICARE: EXCEL OCCUPATIONAL THERAPY SERVICES P.C.

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	0008777	NY

General Provider Information

NPI Number	:	1962870162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL OCCUPATIONAL THERAPY SERVICES P.C.

Provider Business Mailing Address
First Line	:	1445 GENEVA LOOP APT 10C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11239-2414
Country	:	US
Telephone Number	:	646-379-8808
Fax Number	:

Provider Business Practice Location Address
First Line	:	2906 BRIGHTON 12TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4753
Country	:	US
Telephone Number	:	718-604-5469
Fax Number	:

Authorized Official
Title or Position	:	OTR
Name	:	MAYURA KANEKER
Credential	:
Telephone Number	:	718-604-5469

Provider Enumeration Date	:	09/04/2015
Last Update Date	:	09/04/2015

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