Provider Demographics
NPI:1174123913
Name:BE THE CHANGE OCCUPATIONAL THERAPY PC
Entity type:Organization
Organization Name:BE THE CHANGE OCCUPATIONAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:718-208-5389
Mailing Address - Street 1:687 E 58TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1004
Mailing Address - Country:US
Mailing Address - Phone:718-208-5389
Mailing Address - Fax:
Practice Address - Street 1:GARDEN OF EDEN HOME FOR ADULTS (OT/PT OFFICE)
Practice Address - Street 2:1608 STILLWELL AVE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223
Practice Address - Country:US
Practice Address - Phone:718-208-5389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty