Provider Demographics
NPI:1073795779
Name:CYRILLE, CARLINE AGNES (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CARLINE
Middle Name:AGNES
Last Name:CYRILLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:CARLINE
Other - Middle Name:
Other - Last Name:CYRILLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:245-27 77 CRESCENT
Mailing Address - Street 2:APT B
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426
Mailing Address - Country:US
Mailing Address - Phone:347-996-2471
Mailing Address - Fax:
Practice Address - Street 1:245-27 77CRESCENT
Practice Address - Street 2:APT B
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1002
Practice Address - Country:US
Practice Address - Phone:347-996-2471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013776-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist