Individual
JUDENER FONTILUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
135 LINDEN BLVD, BROOKLYN, NY 11226-3302
(718) 576-7000
Mailing address
712 CALICO CT APT E, TERRE HAUTE, IN 47803-4252
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
08/15/2018
Last updated
08/15/2018
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