Provider Demographics
NPI:1356659577
Name:POPOWYTSCH, CAROL (OTR)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:POPOWYTSCH
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 1:217 SAINT MARKS PL
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6426
Mailing Address - Country:US
Mailing Address - Phone:845-641-6981
Mailing Address - Fax:
Practice Address - Street 1:12 ALAN CT
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2623
Practice Address - Country:US
Practice Address - Phone:845-641-6981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003836-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist