Individual
MRS. DOREEN H FERTEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA. OTR/L
Contact information
Practice address
1022 78TH ST, BROOKLYN, NY 11228-2612
(718) 745-5922
Mailing address
1022 78TH ST, BROOKLYN, NY 11228-2612
(718) 745-5922
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
004203-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q78911
EMPIRE BLUE CROSS BLUE SHIELD
NY
Enumeration date
11/04/2008
Last updated
12/05/2021
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