Provider Demographics
NPI:1760566525
Name:PHANSALKAR, HELIANA (OT)
Entity Type:Individual
Prefix:
First Name:HELIANA
Middle Name:
Last Name:PHANSALKAR
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:HELIANA
Other - Middle Name:F
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:9619 158TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3245
Mailing Address - Country:US
Mailing Address - Phone:646-266-2189
Mailing Address - Fax:718-951-0846
Practice Address - Street 1:9619 158TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3245
Practice Address - Country:US
Practice Address - Phone:646-266-2189
Practice Address - Fax:718-951-0846
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013419-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013419-1OtherLICENSE#