Provider Demographics
NPI:1376818252
Name:ESPARRA, AVELYN (OTR)
Entity Type:Individual
Prefix:
First Name:AVELYN
Middle Name:
Last Name:ESPARRA
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 1:15 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1823
Mailing Address - Country:US
Mailing Address - Phone:718-984-9800
Mailing Address - Fax:718-356-8712
Practice Address - Street 1:15 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1823
Practice Address - Country:US
Practice Address - Phone:718-984-9800
Practice Address - Fax:718-356-8712
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013731-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics