Provider Demographics
NPI: | 1518285287 |
---|---|
Name: | DEASE, WILLIAM DANIEL III (OTR) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | WILLIAM |
Middle Name: | DANIEL |
Last Name: | DEASE |
Suffix: | III |
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: | 6800 JERICHO TPKE |
Mailing Address - Street 2: | SUITE 120W |
Mailing Address - City: | SYOSSET |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11791-4436 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 631-600-3029 |
Mailing Address - Fax: | 800-783-5909 |
Practice Address - Street 1: | 6800 JERICHO TPKE |
Practice Address - Street 2: | SUITE 120W |
Practice Address - City: | SYOSSET |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11791-4436 |
Practice Address - Country: | US |
Practice Address - Phone: | 631-600-3029 |
Practice Address - Fax: | 800-783-5909 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2010-05-05 |
Last Update Date: | 2017-02-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 007477 | 225X00000X, 225XE0001X, 225XE1200X, 225XF0002X, 225XG0600X, 225XN1300X, 225XP0019X, 225XP0200X, 225XR0403X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | |
No | 225XE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification |
No | 225XE1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Ergonomics |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing |
No | 225XG0600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology |
No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No | 225XR0403X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Driving and Community Mobility |