Provider Demographics
NPI:1376731174
Name:OCCUPATIONAL THERAPY FOR PRODUCTIVE LIVING, PC
Entity Type:Organization
Organization Name:OCCUPATIONAL THERAPY FOR PRODUCTIVE LIVING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT-RAGKASWAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-612-4400
Mailing Address - Street 1:31 E MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5814
Mailing Address - Country:US
Mailing Address - Phone:516-612-4400
Mailing Address - Fax:516-612-4399
Practice Address - Street 1:31 E MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5814
Practice Address - Country:US
Practice Address - Phone:516-612-4400
Practice Address - Fax:516-612-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13891-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100020014Medicare PIN
NY6251950001Medicare NSC