Provider Demographics
NPI:1144864075
Name:GENTILE, EMMA M (OTR/L)
Entity type:Individual
Prefix:MS
First Name:EMMA
Middle Name:M
Last Name:GENTILE
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 1:284 MOTT ST APT 9Q
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3498
Mailing Address - Country:US
Mailing Address - Phone:914-413-9899
Mailing Address - Fax:
Practice Address - Street 1:284 MOTT ST APT 9Q
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3498
Practice Address - Country:US
Practice Address - Phone:914-413-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023691225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist