Provider Demographics
NPI:1114082583
Name:REYES, ROWENA LONTOK (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ROWENA
Middle Name:LONTOK
Last Name:REYES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:ROWENA
Other - Middle Name:CRISTINA
Other - Last Name:LONTOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PSC 475 BX1
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96350-1200
Mailing Address - Country:US
Mailing Address - Phone:315-243-7260
Mailing Address - Fax:
Practice Address - Street 1:PSC 475 BX1
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96350-1200
Practice Address - Country:US
Practice Address - Phone:011-315-7260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005561-1225X00000X
NJ46TR00346900225X00000X
NY005561225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist