Individual
YENDI FENELON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
134 GREAT EAST NECK RD, WEST BABYLON, NY 11704-8027
(631) 422-4800
Mailing address
97 LINCOLN AVE, DEER PARK, NY 11729-7015
(631) 522-0137
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
009987-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0399733
NYSED
NY
Enumeration date
05/18/2020
Last updated
05/18/2020
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