Provider Demographics
NPI:1306375126
Name:DEGEORGE, WILLIAM A (OTR/L)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:DEGEORGE
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 1:122 CORSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2943
Mailing Address - Country:US
Mailing Address - Phone:718-354-9254
Mailing Address - Fax:
Practice Address - Street 1:1049 - 38TH STREET
Practice Address - Street 2:STEP BY STEP INFANT DEVELOPMENT CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-633-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021357225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics