Provider Demographics
NPI:1740425958
Name:BLOCK, SANDRA (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:THIELLS
Mailing Address - State:NY
Mailing Address - Zip Code:10984-1424
Mailing Address - Country:US
Mailing Address - Phone:845-304-6889
Mailing Address - Fax:845-429-9646
Practice Address - Street 1:20 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:THIELLS
Practice Address - State:NY
Practice Address - Zip Code:10984-1424
Practice Address - Country:US
Practice Address - Phone:845-304-6889
Practice Address - Fax:845-429-9646
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012736/1171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator