Provider Demographics
NPI:1558731737
Name:VALCOURT, ANTOINE FREDERIC (OTR)
Entity Type:Individual
Prefix:
First Name:ANTOINE
Middle Name:FREDERIC
Last Name:VALCOURT
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 1:212 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1922
Mailing Address - Country:US
Mailing Address - Phone:806-290-1172
Mailing Address - Fax:631-938-0739
Practice Address - Street 1:1842 E JERICHO TPKE UNIT P
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-5796
Practice Address - Country:US
Practice Address - Phone:631-486-7900
Practice Address - Fax:631-938-0739
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116483225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist