Provider Demographics
NPI:1417372970
Name:PUTHAN, ULLAS (OT)
Entity Type:Individual
Prefix:
First Name:ULLAS
Middle Name:
Last Name:PUTHAN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6254 97TH PL
Mailing Address - Street 2:SUITE - 1A
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1346
Mailing Address - Country:US
Mailing Address - Phone:718-393-3844
Mailing Address - Fax:718-393-3479
Practice Address - Street 1:6254 97TH PL
Practice Address - Street 2:SUITE - 1A
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1346
Practice Address - Country:US
Practice Address - Phone:718-393-3844
Practice Address - Fax:718-393-3479
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016324225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist