Individual
MS. DENISE A SUPON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
620 E 13TH ST, NEW YORK, NY 10009-3615
(212) 674-5280
Mailing address
1963 77TH ST, EAST ELMHURST, NY 11370-1206
(718) 956-1350
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
005379-1
NY
Other
Enumeration date
05/17/2007
Last updated
07/08/2007
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