Provider Demographics
NPI:1215220272
Name:PASSANTE, RUSSELL V (MA, OTR/L)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:V
Last Name:PASSANTE
Suffix:
Gender:M
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 DONALD LN
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-3912
Mailing Address - Country:US
Mailing Address - Phone:914-469-0298
Mailing Address - Fax:
Practice Address - Street 1:36 DONALD LN
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-3912
Practice Address - Country:US
Practice Address - Phone:914-469-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017776225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist