Provider Demographics
NPI:1396382149
Name:NY OT REHABILITATION SERVICES P.C.
Entity Type:Organization
Organization Name:NY OT REHABILITATION SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAURIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:917-741-0252
Mailing Address - Street 1:20 LENOX AVE APT 2Q
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3822
Mailing Address - Country:US
Mailing Address - Phone:917-741-0252
Mailing Address - Fax:
Practice Address - Street 1:20 LENOX AVE APT 2Q
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3822
Practice Address - Country:US
Practice Address - Phone:917-741-0252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty