Individual
JILISA HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
28 MOULTRIE AVE, YONKERS, NY 10710-5410
(718) 304-4475
Mailing address
28 MOULTRIE AVE, YONKERS, NY 10710-5410
(718) 304-4475
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
380338
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0646693726-8
HEALTHCARE PROVIDER SERVICE
NY
Enumeration date
07/16/2017
Last updated
07/21/2022
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