Provider Demographics
NPI:1972892156
Name:PARK, ESTHER (MSOTR/L)
Entity Type:Individual
Prefix:MS
First Name:ESTHER
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E 84TH ST
Mailing Address - Street 2:APT 3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:312 E 84TH ST
Practice Address - Street 2:APT 3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4416
Practice Address - Country:US
Practice Address - Phone:562-277-6637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015968225X00000X
CA10609225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist