Provider Demographics
NPI:1902352636
Name:DYNAMIC CARE OCCUPATIONAL THERAPY, PC
Entity Type:Organization
Organization Name:DYNAMIC CARE OCCUPATIONAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:SIMONE
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:347-678-3601
Mailing Address - Street 1:147-66 253 STREET
Mailing Address - Street 2:
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2801
Mailing Address - Country:US
Mailing Address - Phone:347-678-3601
Mailing Address - Fax:
Practice Address - Street 1:14766 253RD STREET
Practice Address - Street 2:1ST FLOOR
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11422-2801
Practice Address - Country:US
Practice Address - Phone:347-678-3601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015722251C00000X, 251E00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health