Provider Demographics
NPI:1013689157
Name:ORTIZ, DIEGO ISRAEL (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:DIEGO
Middle Name:ISRAEL
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1109
Mailing Address - Country:US
Mailing Address - Phone:718-755-2867
Mailing Address - Fax:
Practice Address - Street 1:538A LEONARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-6610
Practice Address - Country:US
Practice Address - Phone:212-301-0540
Practice Address - Fax:218-231-4830
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019760-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist