Provider Demographics
NPI:1033677612
Name:PROCARE OCCUPATIONAL THERAPY AND PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:PROCARE OCCUPATIONAL THERAPY AND PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-775-0971
Mailing Address - Street 1:191 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4899
Mailing Address - Country:US
Mailing Address - Phone:631-775-0971
Mailing Address - Fax:631-475-0975
Practice Address - Street 1:191 PATCHOGUE YAPHANK RD
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4899
Practice Address - Country:US
Practice Address - Phone:631-775-0971
Practice Address - Fax:631-475-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY019330OtherNYS OT LICENSE