Provider Demographics
NPI:1851620173
Name:VENETIAN OCCUPATIONAL THERAPY PLCC
Entity Type:Organization
Organization Name:VENETIAN OCCUPATIONAL THERAPY PLCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:631-932-0268
Mailing Address - Street 1:1406 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-1628
Mailing Address - Country:US
Mailing Address - Phone:631-932-0268
Mailing Address - Fax:
Practice Address - Street 1:1406 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-1628
Practice Address - Country:US
Practice Address - Phone:631-932-0268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009547-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency