Individual
AMBRYEL MARIE MODER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
35 LONGWOOD RD, MIDDLE ISLAND, NY 11953-2045
(631) 924-0008
Mailing address
35 LONGWOOD RD, MIDDLE ISLAND, NY 11953-2045
(631) 924-0008
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
022276
NY
225X00000X
Occupational Therapist
P07796
NY
Other
Enumeration date
08/30/2017
Last updated
03/17/2018
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