Provider Demographics
NPI:1053932137
Name:COMPLETE OT AND OTA SERVICES PLLC
Entity type:Organization
Organization Name:COMPLETE OT AND OTA SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L CHT CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-834-4027
Mailing Address - Street 1:2545 HEMPSTEAD TPKE STE LL4
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2143
Mailing Address - Country:US
Mailing Address - Phone:516-330-2912
Mailing Address - Fax:516-605-0156
Practice Address - Street 1:9131 QUEENS BLVD STE 310
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5540
Practice Address - Country:US
Practice Address - Phone:718-424-7856
Practice Address - Fax:718-424-6748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11617928OtherCAQH