Individual
MR. THEODORE J PARKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9 SIMON AVE, CENTEREACH, NY 11720-4408
(631) 766-2897
Mailing address
9 SIMON AVE, CENTEREACH, NY 11720-4408
(631) 766-2897
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
011538-1
NY
Other
Enumeration date
10/03/2011
Last updated
10/03/2011
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