Provider Demographics
NPI:1093381147
Name:FUNCTIONAL LIVING OCCUPATIONAL THERAPY, P.L.L.C.
Entity Type:Organization
Organization Name:FUNCTIONAL LIVING OCCUPATIONAL THERAPY, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:DEIRO
Authorized Official - Last Name:BERRYESSA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:347-930-9842
Mailing Address - Street 1:799 PRESIDENT ST
Mailing Address - Street 2:#2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215
Mailing Address - Country:US
Mailing Address - Phone:347-930-9842
Mailing Address - Fax:718-638-5508
Practice Address - Street 1:799 PRESIDENT ST
Practice Address - Street 2:#2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:347-930-9842
Practice Address - Fax:718-638-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty