Individual
DIANA MAMONOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L, MSOT
Contact information
Practice address
6360 102ND ST APT B17, REGO PARK, NY 11374-2435
(718) 490-2267
Mailing address
6360 102ND ST APT B17, REGO PARK, NY 11374-2435
(718) 490-2267
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
029768
NY
Other
Enumeration date
12/12/2024
Last updated
12/12/2024
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