Provider Demographics
NPI:1003148560
Name:OT SKILLED CARE PC
Entity Type:Organization
Organization Name:OT SKILLED CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOUFER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:917-681-0338
Mailing Address - Street 1:2525 BATCHELDER ST
Mailing Address - Street 2:APT 1K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1453
Mailing Address - Country:US
Mailing Address - Phone:917-681-0338
Mailing Address - Fax:
Practice Address - Street 1:1009 BRIGHTON BEACH AVE
Practice Address - Street 2:STE 1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5621
Practice Address - Country:US
Practice Address - Phone:718-332-3200
Practice Address - Fax:718-332-3319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty