Provider Demographics
NPI:1356050611
Name:WHITTY, DOUGLAS JAMES JR (OTR/L)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JAMES
Last Name:WHITTY
Suffix:JR
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 CORTELYOU AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2404
Mailing Address - Country:US
Mailing Address - Phone:718-213-0730
Mailing Address - Fax:
Practice Address - Street 1:330 9TH ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4026
Practice Address - Country:US
Practice Address - Phone:171-843-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027252225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY027252OtherNYS EDUCATION DEPARTMENT