Provider Demographics
NPI:1598073892
Name:CANAL, GEORGE JAKE (OCCUP THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:JAKE
Last Name:CANAL
Suffix:
Gender:M
Credentials:OCCUP THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 CHRISTINE RD
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1774
Mailing Address - Country:US
Mailing Address - Phone:646-339-4439
Mailing Address - Fax:
Practice Address - Street 1:1401 CHRISTINE RD
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1774
Practice Address - Country:US
Practice Address - Phone:646-339-4439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006932225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY931767939OtherUNITED FEDERATION OF TEACHERS