Provider Demographics
NPI:1427402247
Name:ATLAN, SALLY (OT)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:ATLAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7105
Mailing Address - Country:US
Mailing Address - Phone:646-379-7014
Mailing Address - Fax:
Practice Address - Street 1:8829 FORT HAMILTON PKWY APT D01
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6013
Practice Address - Country:US
Practice Address - Phone:646-379-7014
Practice Address - Fax:212-601-2671
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020507-01225XN1300X
NY020507-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07321497Medicaid