Provider Demographics
NPI:1316418007
Name:MCLAUGHLIN, TRAVIS GERALD (OTR/L)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:GERALD
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W 135TH ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-2805
Mailing Address - Country:US
Mailing Address - Phone:917-858-0790
Mailing Address - Fax:
Practice Address - Street 1:1115 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-2507
Practice Address - Country:US
Practice Address - Phone:718-617-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110666026Medicaid