Provider Demographics
NPI:1699090548
Name:HORIZONS OCCUPATIONAL THERAPY PLLC
Entity type:Organization
Organization Name:HORIZONS OCCUPATIONAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:607-857-4909
Mailing Address - Street 1:546 VETERAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-7265
Mailing Address - Country:US
Mailing Address - Phone:607-857-4909
Mailing Address - Fax:607-796-5992
Practice Address - Street 1:546 VETERAN HILL RD
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-7265
Practice Address - Country:US
Practice Address - Phone:607-857-4909
Practice Address - Fax:607-796-5992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007064-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02729151Medicaid