Provider Demographics
NPI:1407000995
Name:MIND AND BODY OCCUPATIONAL THERAPY, P.C.
Entity type:Organization
Organization Name:MIND AND BODY OCCUPATIONAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIGITTE
Authorized Official - Middle Name:CARIDAD
Authorized Official - Last Name:DESPORT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:917-603-2385
Mailing Address - Street 1:PO BOX 653
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-0600
Mailing Address - Country:US
Mailing Address - Phone:917-603-2385
Mailing Address - Fax:212-368-1241
Practice Address - Street 1:300 W 135TH ST
Practice Address - Street 2:2S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2731
Practice Address - Country:US
Practice Address - Phone:917-603-2385
Practice Address - Fax:212-368-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009959-1225XP0019X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty