Provider Demographics
NPI:1619272382
Name:MOHAMMED, ROXANNE N (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:N
Last Name:MOHAMMED
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 1:12615 145TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1818
Mailing Address - Country:US
Mailing Address - Phone:718-529-3616
Mailing Address - Fax:
Practice Address - Street 1:559 ATLANTIC AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1530
Practice Address - Country:US
Practice Address - Phone:516-241-3684
Practice Address - Fax:516-887-6174
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004547-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist