Provider Demographics
NPI:1154441129
Name:DOUGLAS O T SERVICES P.C.
Entity Type:Organization
Organization Name:DOUGLAS O T SERVICES P.C.
Other - Org Name:OCCUPATIONAL THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR LIC
Authorized Official - Phone:718-978-3188
Mailing Address - Street 1:609 MIDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1103
Mailing Address - Country:US
Mailing Address - Phone:718-978-3188
Mailing Address - Fax:718-221-5530
Practice Address - Street 1:4319 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3101
Practice Address - Country:US
Practice Address - Phone:718-978-3188
Practice Address - Fax:718-221-5530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06098Medicare PIN