Provider Demographics
NPI:1720391444
Name:MOWATT, GERALDINE LEGEORGIA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:LEGEORGIA
Last Name:MOWATT
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 1:63 BIRCHWOOD DR S
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1941
Mailing Address - Country:US
Mailing Address - Phone:516-812-8549
Mailing Address - Fax:
Practice Address - Street 1:63 BIRCHWOOD DR S
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1941
Practice Address - Country:US
Practice Address - Phone:516-812-8549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002446-1225XG0600X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology