Provider Demographics
NPI:1902511892
Name:BERNABE, LILY (OTR/L)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:BERNABE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 PINE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-6014
Mailing Address - Country:US
Mailing Address - Phone:860-719-2288
Mailing Address - Fax:
Practice Address - Street 1:44 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:CT
Practice Address - Zip Code:06234-1914
Practice Address - Country:US
Practice Address - Phone:860-774-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6064225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist