Provider Demographics
NPI:1841651833
Name:WILLINGHAM, ARNOLD (OTR/L)
Entity type:Individual
Prefix:
First Name:ARNOLD
Middle Name:
Last Name:WILLINGHAM
Suffix:
Gender:M
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 1:6 STUYVESANT OVAL APT 7E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2418
Mailing Address - Country:US
Mailing Address - Phone:212-982-6482
Mailing Address - Fax:
Practice Address - Street 1:6 STUYVESANT OVAL APT 7E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2418
Practice Address - Country:US
Practice Address - Phone:212-982-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020174-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist