MEDICARE: MS. MONICA LAUREN NATHAN OTR/L

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	225XP0200X	Pediatric Occupational Therapist	012801-1	NY

General Provider Information

NPI Number	:	1992950661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MONICA LAUREN NATHAN OTR/L

Provider Business Mailing Address
First Line	:	1115 PROSPECT AVE
Second Line	:	APT 204
City	:	BROOKLYN
State	:	NY
Zip	:	11218-1124
Country	:	US
Telephone Number	:	917-804-3716
Fax Number	:	718-768-2474

Provider Business Practice Location Address
First Line	:	1115 PROSPECT AVE
Second Line	:	APT 204
City	:	BROOKLYN
State	:	NY
Zip	:	11218-1124
Country	:	US
Telephone Number	:	917-804-3716
Fax Number	:	718-768-2474

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

Provider Enumeration Date	:	11/22/2008
Last Update Date	:	11/22/2008

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