Organization
FUNDAMENTAL PLAY OCCUPATIONAL THERAPY P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAZOL DAVYDOVA OTR/L (OCCUPATIONAL THERAPY)
(917) 499-1224
Entity
Organization
Contact information
Practice address
6545 PARSONS BLVD APT 3J, FRESH MEADOWS, NY 11365-2419
(917) 499-1224
Mailing address
6545 PARSONS BLVD APT 3J, FRESH MEADOWS, NY 11365-2419
(917) 499-1224
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
020599
NY
Other
Enumeration date
01/31/2018
Last updated
05/19/2021
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