Basic Information
| Provider Information | |||||||||
| NPI: | 1558486605 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIGNATURE HAND THERAPY O.T. P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1555 SUNRISE HWY | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | BAY SHORE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117066027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312063130 | ||||||||
| FaxNumber: | 6312063148 | ||||||||
| Practice Location | |||||||||
| Address1: | 1555 SUNRISE HWY | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | BAY SHORE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117066027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312063130 | ||||||||
| FaxNumber: | 6312063148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 08/30/2010 | ||||||||
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| AuthorizedOfficialLastName: | DEMETRIOU | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDRA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPIST OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6312063130 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | OTRL CHT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 007141-1 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.