Provider Demographics
NPI:1104102698
Name:INTEGRATED OCCUPATIONAL THERAPY SERVICES
Entity type:Organization
Organization Name:INTEGRATED OCCUPATIONAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:EBOLI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:718-938-3302
Mailing Address - Street 1:17 N CHATSWORTH AVE
Mailing Address - Street 2:APT. 4F
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 N CHATSWORTH AVE
Practice Address - Street 2:APT. 4F
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2109
Practice Address - Country:US
Practice Address - Phone:718-938-3302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty