Provider Demographics
NPI:1972169423
Name:ITHERAPY OT, PC.
Entity Type:Organization
Organization Name:ITHERAPY OT, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVY GRACE
Authorized Official - Middle Name:MANDAP
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:914-426-9779
Mailing Address - Street 1:8829 180TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4737
Mailing Address - Country:US
Mailing Address - Phone:914-426-9779
Mailing Address - Fax:718-880-1240
Practice Address - Street 1:339 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-6122
Practice Address - Country:US
Practice Address - Phone:914-426-9779
Practice Address - Fax:718-880-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18985OtherNYSED