Provider Demographics
NPI:1831400613
Name:COHEN, ELLIE S (OTR)
Entity type:Individual
Prefix:
First Name:ELLIE
Middle Name:S
Last Name:COHEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FAIRWAY OVAL
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1723
Mailing Address - Country:US
Mailing Address - Phone:617-715-0650
Mailing Address - Fax:
Practice Address - Street 1:962 MANOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7011
Practice Address - Country:US
Practice Address - Phone:973-769-7325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013484225X00000X
NJ46TR00071700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist