Provider Demographics
NPI:1083095400
Name:MEDALION OCCUPATIONAL THERAPY CONSULTING PLLC
Entity Type:Organization
Organization Name:MEDALION OCCUPATIONAL THERAPY CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEEAT
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDALION
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR/L
Authorized Official - Phone:917-498-3034
Mailing Address - Street 1:2820 214TH PL
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2626
Mailing Address - Country:US
Mailing Address - Phone:917-498-3034
Mailing Address - Fax:
Practice Address - Street 1:2820 214TH PL
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2626
Practice Address - Country:US
Practice Address - Phone:917-498-3034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)