Provider Demographics
NPI:1811363724
Name:LIVEWELL OCCUPATIONAL THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:LIVEWELL OCCUPATIONAL THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR, OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MILENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALICANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:347-466-1529
Mailing Address - Street 1:24222 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1507
Mailing Address - Country:US
Mailing Address - Phone:347-466-1529
Mailing Address - Fax:
Practice Address - Street 1:1999 MARCUS AVE STE M15
Practice Address - Street 2:
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-1033
Practice Address - Country:US
Practice Address - Phone:516-488-8808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004958-1261QR0400X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation