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NPI Code Detail

MEDICARE: ENERGY RESOLUTION THEORIES, LLC LEAH FAZAL SOLE MBR

MEDICARE: ENERGY RESOLUTION THEORIES, LLC LEAH FAZAL SOLE MBR
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
1225X00000XOccupational Therapist

General Provider Information

NPI Number : 1992375372
Entity Type Code : Organization
Provider Name (Legal Business Name) : ENERGY RESOLUTION THEORIES, LLC LEAH FAZAL SOLE MBR
Provider Business Mailing Address
First Line : 139 FOSTER AVE
Second Line :
City : VALLEY STREAM
State : NY
Zip : 11580-4726
Country : US
Telephone Number : 718-791-8950
Fax Number :
Provider Business Practice Location Address
First Line : 11 IRVING PL
Second Line :
City : WOODMERE
State : NY
Zip : 11598-1256
Country : US
Telephone Number : 718-791-8950
Fax Number :
Authorized Official
Title or Position : OWNER
Name : LEAH FAZAL
Credential : OTR/L
Telephone Number : 718-791-8950
Provider Enumeration Date : 06/29/2021
Last Update Date : 06/29/2021

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Directions to “ENERGY RESOLUTION THEORIES, LLC LEAH FAZAL SOLE MBR ” Practice Location

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