Provider Demographics
NPI:1326395302
Name:BEYROUTI, ALINE (OTR)
Entity Type:Individual
Prefix:MR
First Name:ALINE
Middle Name:
Last Name:BEYROUTI
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 1:521 W 112TH ST
Mailing Address - Street 2:APT 32
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1631
Mailing Address - Country:US
Mailing Address - Phone:970-744-9169
Mailing Address - Fax:
Practice Address - Street 1:521 W 112TH ST
Practice Address - Street 2:APT 32
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1631
Practice Address - Country:US
Practice Address - Phone:970-744-9169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017451-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist