Provider Demographics
NPI:1548635238
Name:NEUROADEPT OCCUPATIONAL THERAPIST
Entity type:Organization
Organization Name:NEUROADEPT OCCUPATIONAL THERAPIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:KOWAL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:845-313-2382
Mailing Address - Street 1:168 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:SPARROW BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12780-5440
Mailing Address - Country:US
Mailing Address - Phone:845-313-2382
Mailing Address - Fax:845-810-7013
Practice Address - Street 1:168 WILSON RD
Practice Address - Street 2:
Practice Address - City:SPARROW BUSH
Practice Address - State:NY
Practice Address - Zip Code:12780-5440
Practice Address - Country:US
Practice Address - Phone:845-313-2382
Practice Address - Fax:845-810-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-06
Last Update Date:2015-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008641-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty