Provider Demographics
NPI:1790081339
Name:SANTOS, SANDRA ISABEL (OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ISABEL
Last Name:SANTOS
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LEXINGTON AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8971
Mailing Address - Country:US
Mailing Address - Phone:915-252-9265
Mailing Address - Fax:
Practice Address - Street 1:577 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4383
Practice Address - Country:US
Practice Address - Phone:212-254-7300
Practice Address - Fax:212-254-7300
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-30
Last Update Date:2011-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015187225X00000X, 225XP0200X
015187225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics