Provider Demographics
NPI:1023148079
Name:LEDEK, PATRICIA ANGELA (OT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANGELA
Last Name:LEDEK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:ANGELA
Other - Last Name:AMBRICO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:78 HEADLINE RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-6210
Mailing Address - Country:US
Mailing Address - Phone:631-721-7280
Mailing Address - Fax:
Practice Address - Street 1:300 MOTOR PKWY
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5171
Practice Address - Country:US
Practice Address - Phone:631-439-6861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011894225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist