Provider Demographics
NPI:1194126581
Name:SPECTRUM OCCUPATIONAL THERAPY, PC
Entity type:Organization
Organization Name:SPECTRUM OCCUPATIONAL THERAPY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, MS
Authorized Official - Phone:646-620-0403
Mailing Address - Street 1:8400 SHORE FRONT PKWY APT 5A
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1809
Mailing Address - Country:US
Mailing Address - Phone:646-620-0403
Mailing Address - Fax:
Practice Address - Street 1:8400 SHORE FRONT PKWY APT 5A
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1809
Practice Address - Country:US
Practice Address - Phone:646-620-0403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013504225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEARLY INTERVENTION OCCUPATIONAL THERAPY PROVIDER