Provider Demographics
NPI:1033553110
Name:PEDIATRIC OCCUPATIONAL THERAPY SERVICES OF BROOKLYN, P.C.45
Entity Type:Organization
Organization Name:PEDIATRIC OCCUPATIONAL THERAPY SERVICES OF BROOKLYN, P.C.45
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DILEONARDO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:646-421-7653
Mailing Address - Street 1:1464 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1464 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4025
Practice Address - Country:US
Practice Address - Phone:646-421-7653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016238252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency