Provider Demographics
NPI:1417409814
Name:SUNSHINE PEDIATRIC OCCUPATIONAL THERAPY PC
Entity Type:Organization
Organization Name:SUNSHINE PEDIATRIC OCCUPATIONAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HIMBELE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:631-207-2882
Mailing Address - Street 1:12 HOLLY HILL CT
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2527
Mailing Address - Country:US
Mailing Address - Phone:631-207-2882
Mailing Address - Fax:631-207-2882
Practice Address - Street 1:12 HOLLY HILL CT
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-2527
Practice Address - Country:US
Practice Address - Phone:631-207-2882
Practice Address - Fax:631-207-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty