Provider Demographics
NPI:1316090541
Name:BASSECHES, THOMAS JAN (OT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JAN
Last Name:BASSECHES
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 DAVIS AVE
Mailing Address - Street 2:APT # 3H
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1031
Mailing Address - Country:US
Mailing Address - Phone:914-682-4315
Mailing Address - Fax:
Practice Address - Street 1:47 DAVIS AVE
Practice Address - Street 2:APT # 3H
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1031
Practice Address - Country:US
Practice Address - Phone:914-682-4315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005437-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005437-1OtherOCCUPATIONAL THERAPY LICE