Provider Demographics
NPI:1063051456
Name:WELL STREET OCCUPATIONAL THERAPY, PLLC
Entity type:Organization
Organization Name:WELL STREET OCCUPATIONAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:H
Authorized Official - Last Name:UM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:347-832-8012
Mailing Address - Street 1:3960 54TH ST APT 7P
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4217
Mailing Address - Country:US
Mailing Address - Phone:347-832-8012
Mailing Address - Fax:
Practice Address - Street 1:3960 54TH ST APT 7P
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4217
Practice Address - Country:US
Practice Address - Phone:347-832-8012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy