Provider Demographics
NPI:1528594421
Name:VAN ATTA, JOHN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:VAN ATTA
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 OCEAN PKWY
Mailing Address - Street 2:APT 4L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3260
Mailing Address - Country:US
Mailing Address - Phone:917-657-1051
Mailing Address - Fax:
Practice Address - Street 1:250 OCEAN PKWY
Practice Address - Street 2:APT 4L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3260
Practice Address - Country:US
Practice Address - Phone:917-657-1051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021483225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist