Provider Demographics
NPI:1275904203
Name:LETTERESE, THOMAS (OTR/L)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:LETTERESE
Suffix:
Gender:M
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 1:35 DAVENPORT AVE APT 3G
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3411
Mailing Address - Country:US
Mailing Address - Phone:845-893-2459
Mailing Address - Fax:
Practice Address - Street 1:35 DAVENPORT AVE APT 3G
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-3411
Practice Address - Country:US
Practice Address - Phone:845-893-2459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019471-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist