Provider Demographics
NPI:1609287333
Name:JOEL, ATARA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ATARA
Middle Name:
Last Name:JOEL
Suffix:
Gender:F
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 1:3720 INDEPENDENCE AVE
Mailing Address - Street 2:APT 6A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1429
Mailing Address - Country:US
Mailing Address - Phone:646-220-5059
Mailing Address - Fax:
Practice Address - Street 1:655 W 254TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1247
Practice Address - Country:US
Practice Address - Phone:718-549-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018651225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist