Provider Demographics
NPI:1831487933
Name:SENSORY TREE, PEDIATRIC OT SERVICES, PLLC
Entity Type:Organization
Organization Name:SENSORY TREE, PEDIATRIC OT SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ROSALIA
Authorized Official - Last Name:RANDAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS OF ARTS
Authorized Official - Phone:347-446-6754
Mailing Address - Street 1:7410 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5703
Mailing Address - Country:US
Mailing Address - Phone:347-446-6754
Mailing Address - Fax:
Practice Address - Street 1:7410 20TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5703
Practice Address - Country:US
Practice Address - Phone:347-446-6754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty