Active NPI
Mandalee Harriott
- Occupational Therapy Assistant
- Queens Village, NY
National Provider Identifier
1407912900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 1016238
- Practice address
- 21857 110TH Ave
Queens Village, NY 11429-2516 - Phone
- (917) 279-6819
- NPI assigned
- Dec 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 1016238 | NY | Primary |
Addresses
Primary practice location
21857 110TH Ave
Queens Village, NY 11429-2516
Mailing address
21857 110 Ave
Queensvillage, NY 11429
Phone (917) 279-6819
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 |
|---|---|---|---|
| 1016238 | NY | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407912900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21857 110 AVE",
"city": "QUEENSVILLAGE",
"state": "NY",
"postal_code": "11429",
"telephone_number": "917-279-6819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21857 110TH AVE",
"city": "QUEENS VILLAGE",
"state": "NY",
"postal_code": "114292516",
"telephone_number": "917-279-6819"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIOTT",
"first_name": "MANDALEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NY",
"license": "1016238",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Queens Village, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.