Provider Demographics
NPI:1649620279
Name:DOVE OCCUPATIONAL THERAPY PC
Entity type:Organization
Organization Name:DOVE OCCUPATIONAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CUEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR/L
Authorized Official - Phone:917-696-2036
Mailing Address - Street 1:11 CHRISTOPHER CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-2054
Mailing Address - Country:US
Mailing Address - Phone:917-696-2036
Mailing Address - Fax:
Practice Address - Street 1:11 CHRISTOPHER CT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-2054
Practice Address - Country:US
Practice Address - Phone:917-696-2036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014475-1320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities