Provider Demographics
NPI:1811188345
Name:PARASRAM, DEOLAL DEREK (OT)
Entity Type:Individual
Prefix:MR
First Name:DEOLAL
Middle Name:DEREK
Last Name:PARASRAM
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120-11-HILLSIDE AVE, APT 3J
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418
Mailing Address - Country:US
Mailing Address - Phone:347-247-8780
Mailing Address - Fax:
Practice Address - Street 1:120-11-HILLSIDE AVENUE, APT 3J
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1828
Practice Address - Country:US
Practice Address - Phone:718-835-1946
Practice Address - Fax:718-322-2888
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013871-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist