Provider Demographics
NPI:1164844353
Name:SEMCZUK, ALLIS JAYNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALLIS
Middle Name:JAYNE
Last Name:SEMCZUK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 48TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1111
Mailing Address - Country:US
Mailing Address - Phone:917-453-3830
Mailing Address - Fax:
Practice Address - Street 1:2532 48TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-1111
Practice Address - Country:US
Practice Address - Phone:917-453-3830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist