Provider Demographics
NPI:1528344231
Name:KING, DAVID P (OTR/L)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:P
Last Name:KING
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:P
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:73-50 BELL BLVD APT 1D
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364
Mailing Address - Country:US
Mailing Address - Phone:646-334-7805
Mailing Address - Fax:
Practice Address - Street 1:7350 BELL BLVD APT 1D
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-2920
Practice Address - Country:US
Practice Address - Phone:646-334-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7156225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist