Provider Demographics
NPI:1285035725
Name:PALLADINO, AIMEE LISSET (OTR/L)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:LISSET
Last Name:PALLADINO
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 1:4626 BEACH 46TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1004
Mailing Address - Country:US
Mailing Address - Phone:516-690-5327
Mailing Address - Fax:
Practice Address - Street 1:4626 BEACH 46TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1004
Practice Address - Country:US
Practice Address - Phone:516-690-5327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2019-03-28
Deactivation Date:2019-03-04
Deactivation Code:
Reactivation Date:2019-03-27
Provider Licenses
StateLicense IDTaxonomies
NY008518-1224Z00000X
NY023443225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant