Provider Demographics
NPI:1003632795
Name:TEIXEIRA, ANTHONY TEIXEIRA LAWRENCE JR (COTA/L)
Entity type:Individual
Prefix:MR
First Name:ANTHONY TEIXEIRA
Middle Name:LAWRENCE
Last Name:TEIXEIRA
Suffix:JR
Gender:M
Credentials:COTA/L
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Other - Credentials:
Mailing Address - Street 1:28 RIBBON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-4304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1325 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1666
Practice Address - Country:US
Practice Address - Phone:603-724-4253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY009619225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist