Quotation Estimate Occupational Therapist in United States New York City –Free Word Template Download with AI
245 West 42nd Street, Suite 1200, New York, NY 10036
Phone: (212) 555-0187 | Email: [email protected]
NY State License No. OT-2024-88431 | NPI: 1740298832
Quotation EstimateQuotation Details
Quotation No.: QE-2025-0417-NYC
Date Issued: June 12, 2025
Valid Until: July 12, 2025 (30 days)
Service Location: United States New York City
Occupational Therapist ServicesPrepared For
Client Name: [Client / Facility Name]
Address: [Street Address], New York, NY [ZIP]
Contact: [Phone Number]
Email: [Email Address]
Insurance / Payer: [Provider & Policy No.]
Scope of Services – Occupational TherapistThis Quotation Estimate is issued by Manhattan Rehabilitation & Therapy Associates to provide a comprehensive, itemized cost breakdown for Occupational Therapist services to be delivered within the United States New York City metropolitan area. The Occupational Therapist assigned to this engagement is a licensed New York State Occupational Therapist (OT/L) with a minimum of eight years of clinical experience in adult and geriatric rehabilitation, pediatric developmental therapy, and post-surgical functional restoration. All services described in this Quotation Estimate comply with the New York State Education Department regulations (8 NYCRR Part 29-30) and the standards set forth by the American Occupational Therapy Association (AOTA).
Itemized Services & Pricing| # | Service Description | Frequency | Duration | Unit Rate | Qty | Subtotal |
|---|---|---|---|---|---|---|
| 1 | Initial Occupational Therapist Comprehensive Assessment & Functional Evaluation (including ADL analysis, cognitive screening, and home/work environment review) | One-time | 90 min | $285.00 | 1 | $285.00 |
| 2 | Individual Occupational Therapy Sessions – Functional Restoration & ADL Training (hand therapy, fine motor coordination, adaptive equipment training) | 3x / week | 60 min | $195.00 | 52 | $10,140.00 |
| 3 | Group Occupational Therapy Program – Community Reintegration & Social Participation (held at our United States New York City clinic or client's facility) | 1x / week | 90 min | $145.00 | 13 | $1,885.00 |
| 4 | Home / Workplace Environmental Assessment & Adaptive Equipment Recommendation (Occupational Therapist on-site visit within NYC five boroughs) | One-time | 120 min | $350.00 | 1 | $350.00 |
| 5 | Progress Review & Treatment Plan Revision (quarterly Occupational Therapist clinical review with written report) | Quarterly | 45 min | $160.00 | 1 | $160.00 |
| 6 | Discharge Summary, Final Occupational Therapist Report & Follow-up Care Coordination (includes referral letters to primary care and specialty physicians) | One-time | 60 min | $220.00 | 1 | $220.00 |
| 7 | Adaptive Equipment & Assistive Technology Supply (splints, reachers, modified utensils, environmental modifications as prescribed by the Occupational Therapist) | As needed | — | Varies | 1 | $450.00 |
| 8 | Travel & Transportation Surcharge (Occupational Therapist travel between United States New York City boroughs, parking, and transit costs) | Per visit | — | $25.00 | 67 | $1,675.00 |
| Subtotal: | $15,165.00 | |||||
| Applicable New York State Sales Tax (8.875% on equipment): | $39.94 | |||||
| TOTAL ESTIMATED COST: | $15,204.94 | |||||
1. Validity: This Quotation Estimate is valid for thirty (30) calendar days from the date of issuance. After the expiration date, pricing for the Occupational Therapist services may be subject to revision based on current New York State fee schedules and market adjustments.
2. Payment Terms: Payment is due within thirty (30) days of invoice date. For insurance-billed services, the Occupational Therapist's billing department will submit claims directly to the client's payer. The client is responsible for any co-pays, deductibles, or non-covered amounts as determined by the insurance carrier.
3. Cancellation Policy: Appointments must be rescheduled or cancelled with a minimum of 24 hours' notice. Late cancellations or no-shows will be billed at 50% of the scheduled Occupational Therapist session fee.
4. Scope Limitations: This Quotation Estimate covers the Occupational Therapist services explicitly listed above. Any additional therapeutic interventions, emergency visits, or extended treatment beyond the 13-week program period will require a separate written amendment to this Quotation Estimate.
5. Licensing & Compliance: All Occupational Therapist services are delivered by practitioners holding active New York State Occupational Therapy licenses. Our facility in the United States New York City is fully accredited and in compliance with all applicable federal (HIPAA, ACA) and state (NY Public Health Law) regulations.
6. Confidentiality: All client information, treatment records, and financial data associated with this Quotation Estimate are protected under HIPAA and New York State Mental Hygiene Law. No information will be disclosed without written client consent.
7. Acceptance: By signing below, the client acknowledges receipt of this Quotation Estimate and agrees to the terms outlined herein. This document does not constitute a binding contract until a formal Service Agreement is executed by both parties.
Authorized Representative – ProviderManhattan Rehabilitation & Therapy Associates
Date: ______________________ Client / Authorized Signatory
[Client / Facility Name]
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX
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