Basic Information
| Provider Information | |||||||||
| NPI: | 1417114315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTOOLE | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | CHRISTINA | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25B EDGEWATER PARK | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104653503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9175333325 | ||||||||
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| Practice Location | |||||||||
| Address1: | 51-55 NORTH ROUTE 9W | ||||||||
| Address2: | |||||||||
| City: | W. HAVERSTRAW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457864379 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2008 | ||||||||
| LastUpdateDate: | 05/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 003117-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.