Provider Demographics
NPI:1902046790
Name:DUPREE, THERESA DAVIS (OTR)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:DAVIS
Last Name:DUPREE
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 1:118-18 - 229 STREET
Mailing Address - Street 2:CAMBRIA HEIGHTS QUEENS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11411
Mailing Address - Country:US
Mailing Address - Phone:917-714-2151
Mailing Address - Fax:
Practice Address - Street 1:118-18 - 229 STREET
Practice Address - Street 2:CAMBRIA HEIGHTS NEW YORK
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11411
Practice Address - Country:US
Practice Address - Phone:917-714-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006290-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist