Provider Demographics
NPI:1194969055
Name:SHWOM, ELYCE (OTR/L)
Entity type:Individual
Prefix:
First Name:ELYCE
Middle Name:
Last Name:SHWOM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 VIAN AVE
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1423
Mailing Address - Country:US
Mailing Address - Phone:516-569-2759
Mailing Address - Fax:
Practice Address - Street 1:815 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2922
Practice Address - Country:US
Practice Address - Phone:516-660-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005250225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist