Provider Demographics
NPI:1205143070
Name:DICKSON, BESSIE UFOT
Entity type:Individual
Prefix:MRS
First Name:BESSIE
Middle Name:UFOT
Last Name:DICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BESSIE
Other - Middle Name:UFOT
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28WEST,131STREET,,APT 3A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037
Mailing Address - Country:US
Mailing Address - Phone:212-283-6478
Mailing Address - Fax:
Practice Address - Street 1:28 W 131ST ST APT 3A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3576
Practice Address - Country:US
Practice Address - Phone:212-283-6372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00604-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant