Provider Demographics
NPI:1992265854
Name:OT SKILLS 4 LIFE LLC
Entity type:Organization
Organization Name:OT SKILLS 4 LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WANDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-817-7261
Mailing Address - Street 1:3 PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1925
Mailing Address - Country:US
Mailing Address - Phone:516-817-7261
Mailing Address - Fax:
Practice Address - Street 1:888 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1957
Practice Address - Country:US
Practice Address - Phone:516-817-7261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center