Provider Demographics
NPI:1194000729
Name:ALTSON, AMY R (OTR)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:R
Last Name:ALTSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 LILLIAN ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2626
Mailing Address - Country:US
Mailing Address - Phone:845-354-4519
Mailing Address - Fax:
Practice Address - Street 1:39 LILLIAN ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2626
Practice Address - Country:US
Practice Address - Phone:845-354-4519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004057-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist