Individual
JENNYFAITH O CANILAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
4624 BROADWAY, NEW YORK, NY 10040-2102
(212) 569-1044
Mailing address
715 RAMAPO RD, TEANECK, NJ 07666-1807
(201) 334-6819
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
009683-1
NY
224Z00000X
Occupational Therapy Assistant
46TA09167200
NJ
Other
Enumeration date
04/05/2019
Last updated
04/05/2019
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