Provider Demographics
NPI:1487866323
Name:ELMORE, DREW BENNETT (OTR)
Entity Type:Individual
Prefix:MR
First Name:DREW
Middle Name:BENNETT
Last Name:ELMORE
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 CROYDON DR
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3022
Mailing Address - Country:US
Mailing Address - Phone:516-546-6206
Mailing Address - Fax:
Practice Address - Street 1:3909 214TH PL
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2123
Practice Address - Country:US
Practice Address - Phone:718-229-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005962-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist