Individual
ELDER BERRY PETILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4951 CHAMBERS STREET, 6TH FLOOR, NEW YORK, NY 10007
(917) 286-5305
Mailing address
2112 33RD AVE, APT 3, LONG ISLAND CITY, NY 11106-4236
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
014851
NY
Other
Enumeration date
06/30/2010
Last updated
06/30/2010
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