Provider Demographics
NPI:1841697349
Name:REICH, CICELY (MSOTR/L)
Entity type:Individual
Prefix:
First Name:CICELY
Middle Name:
Last Name:REICH
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 BEVERLEY RD
Mailing Address - Street 2:APT 3W
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3365
Mailing Address - Country:US
Mailing Address - Phone:203-470-3060
Mailing Address - Fax:
Practice Address - Street 1:320 E 65TH ST APT 117
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6744
Practice Address - Country:US
Practice Address - Phone:212-249-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019302-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist