Active NPI
Theresa Shanley Prosek, MS, OTR/L
- Occupational Therapist
- Bayport, NY
National Provider Identifier
1720559909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 020962-1
- Practice address
- 454 Sylvan Ave
Bayport, NY 11705 - Phone
- (631) 383-2375
- NPI assigned
- Dec 16, 2018
- 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 Therapist | 225X00000X | 020962-1 | NY | Primary |
Addresses
Primary practice location
454 Sylvan Ave
Bayport, NY 11705
Mailing address
454 Sylvan Ave
Bayport, NY 11705-1537
Phone (631) 383-2375
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020962-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575504000000",
"number": "1720559909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "454 SYLVAN AVE",
"city": "BAYPORT",
"state": "NY",
"postal_code": "117051537",
"telephone_number": "631-383-2375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "454 SYLVAN AVE",
"city": "BAYPORT",
"state": "NY",
"postal_code": "11705",
"telephone_number": "631-383-2375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROSEK",
"first_name": "THERESA",
"middle_name": "SHANLEY",
"credential": "MS, OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-12-16",
"last_updated": "2019-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "020962-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bayport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.