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NEW YORK STATE SCHEDULE OPWDD-1 SCHEDULE OF SERVICES ICF/IIDs Only Page CONSOLIDATED FISCAL REPORT For the Period July 1 2015 to June 30 2016 AGENCY NAME SITE ADDRESS AGENCY CODE PROGRAM TYPE CODE NUMBER MEDICAID PROVIDER AGREEMENT NUMBER OPERATING CERTIFICATE NUMBER Complete a separate schedule for each site. 19 Acute Care - Occupational Therapy Nursing - Excludes medical services provided by a nurse practitioner. Col. 3 Col. 1 Col. 2 Col. 4 ICF Purchases Exclusively Purchased Amount MA Card...
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