Provider Demographics
NPI:1609009836
Name:PORCARO, PAULETTE R (OTR)
Entity Type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:R
Last Name:PORCARO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W 89TH ST
Mailing Address - Street 2:SUITE#3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2102
Mailing Address - Country:US
Mailing Address - Phone:212-874-2948
Mailing Address - Fax:212-874-2948
Practice Address - Street 1:304 W 89TH ST
Practice Address - Street 2:SUITE#3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2102
Practice Address - Country:US
Practice Address - Phone:212-874-2948
Practice Address - Fax:212-874-2948
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001542-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist