MEDICARE: PATRIQUE HENRY

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	224Z00000X	Occupational Therapy Assistant	008069	NY

General Provider Information

NPI Number	:	1982428785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRIQUE HENRY

Provider Business Mailing Address
First Line	:	174 S ORANGE AVE APT 4
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-2270
Country	:	US
Telephone Number	:	973-626-5663
Fax Number	:	855-678-8887

Provider Business Practice Location Address
First Line	:	174 S ORANGE AVE APT 4
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-2270
Country	:	US
Telephone Number	:	973-626-5663
Fax Number	:	855-678-8887

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

Provider Enumeration Date	:	11/09/2024
Last Update Date	:	11/09/2024

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Directions to “ PATRIQUE HENRY ” Practice Location

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