Provider Demographics
NPI:1225346182
Name:CASTRO, JOHN (OTA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 BRONX PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-2436
Mailing Address - Country:US
Mailing Address - Phone:646-261-7463
Mailing Address - Fax:347-398-0206
Practice Address - Street 1:429 BRONX PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2436
Practice Address - Country:US
Practice Address - Phone:646-261-7463
Practice Address - Fax:347-398-0206
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007003-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant