Kenneth Wachstock, MA, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

0121921 Issued in NY

Practice address

19614 Pompeii Ave
Hollis, NY 11423-1418

Phone

(718) 464-0709

NPI assigned

Mar 22, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237680000000",
    "number": "1295976231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19614 POMPEII AVE",
            "city": "HOLLIS",
            "state": "NY",
            "postal_code": "114231418",
            "telephone_number": "718-464-0709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19614 POMPEII AVE",
            "city": "HOLLIS",
            "state": "NY",
            "postal_code": "114231418",
            "telephone_number": "718-464-0709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACHSTOCK",
        "first_name": "KENNETH",
        "credential": "MA, OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-03-22",
        "last_updated": "2009-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "0121921",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NY",
            "license": "0121921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jean Herve Veillard, NURSE
• Kathryn R Vella
• Veronica Hemmings Dba
• Dasha Vilela
• Barbara Vincent
• Walk-in Pediatric Care PLLC
• Hertha Walters
• Li-Chieh Wang
• Phyllis Dunn Weiner, MD
• Merle Gloria Wellington, LPN

• Pediatric Occupational Therapist in Hollis, NY
• Providers in Hollis, NY by specialty
• Pediatric Occupational Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.