Active NPI
Rebecca Russell
- Occupational Therapist
- Hauppauge, NY
National Provider Identifier
1013520337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 029662-01
- Practice address
- 495 Hoffman LN
Hauppauge, NY 11788-3102 - Phone
- (631) 863-3000
- NPI assigned
- Aug 26, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 029662-01 | NY | Primary |
| Behavior Technician | 106S00000X |
Addresses
Primary practice location
495 Hoffman LN
Hauppauge, NY 11788-3102
Mailing address
25 Louis PL
Nesconset, NY 11767-2250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029662-01 | NY | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Opportunity Pre-School | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Early Intervention Provider Agency
- Hauppauge, NY
- NPI 1023251105
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731542400000",
"number": "1013520337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 LOUIS PL",
"city": "NESCONSET",
"state": "NY",
"postal_code": "117672250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "495 HOFFMAN LN",
"city": "HAUPPAUGE",
"state": "NY",
"postal_code": "117883102",
"telephone_number": "631-863-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "REBECCA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-26",
"last_updated": "2024-11-14",
"certification_date": "2024-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "029662-01",
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hauppauge, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.