Provider Demographics
NPI:1548084080
Name:RICCI, TREVOR JASON (COTA/L)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:JASON
Last Name:RICCI
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 ISHAM ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2038
Mailing Address - Country:US
Mailing Address - Phone:917-359-9103
Mailing Address - Fax:
Practice Address - Street 1:2895 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2415
Practice Address - Country:US
Practice Address - Phone:718-233-8293
Practice Address - Fax:718-701-3133
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011648224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant