Basic Information
| Provider Information | |||||||||
| NPI: | 1639441652 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HANDWORKS OT PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5830 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113555336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188868180 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13939 35TH AVE FL 1 | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113543500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188882600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2012 | ||||||||
| LastUpdateDate: | 02/07/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CARINGAL | ||||||||
| AuthorizedOfficialFirstName: | MOIRA | ||||||||
| AuthorizedOfficialMiddleName: | GYTUERREZ | ||||||||
| AuthorizedOfficialTitleorPosition: | O.T. | ||||||||
| AuthorizedOfficialTelephone: | 7188882600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 015529 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | LICENSE | 01 | NY | 015529 | OTHER |