Provider Demographics
NPI:1053123794
Name:ATTALE, JEANETTE MARIA (OTR/L)
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:MARIA
Last Name:ATTALE
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 1:1198 BROOKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-1826
Mailing Address - Country:US
Mailing Address - Phone:631-681-8148
Mailing Address - Fax:
Practice Address - Street 1:311 NORTH ST STE 406
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2232
Practice Address - Country:US
Practice Address - Phone:914-898-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029883225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist