Individual
BERNICE PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
33 COUNTRY CLUB DR APT A, CORAM, NY 11727-3431
(321) 240-7910
Mailing address
33 COUNTRY CLUB DR APT A, CORAM, NY 11727-3431
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
P09300
NY
Other
Enumeration date
11/19/2018
Last updated
11/19/2018
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