Provider Demographics
NPI:1396506358
Name:LIFE TREE OCCUPATIONAL THERAPY SERVICES PC
Entity type:Organization
Organization Name:LIFE TREE OCCUPATIONAL THERAPY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT
Authorized Official - Prefix:
Authorized Official - First Name:AKINWUNMI
Authorized Official - Middle Name:O
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-659-5966
Mailing Address - Street 1:2552 FENTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 BRAGG ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1144
Practice Address - Country:US
Practice Address - Phone:917-659-5966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center