Individual
MS. DIANE MARIE CEBALLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
611 BROADWAY, SUITE 908, NEW YORK, NY 10012-2608
(212) 473-0011
Mailing address
2119 24TH RD, 1ST FLOOR, ASTORIA, NY 11102-3447
(347) 623-5905
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
P86861
NY
Other
Enumeration date
01/23/2013
Last updated
01/23/2013
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