Provider Demographics
NPI:1275979502
Name:RAMBALLI, SERENA DEVI (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SERENA
Middle Name:DEVI
Last Name:RAMBALLI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:SERENA
Other - Middle Name:DEVI
Other - Last Name:KEMRAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:13316 83RD ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1338
Mailing Address - Country:US
Mailing Address - Phone:917-226-7673
Mailing Address - Fax:
Practice Address - Street 1:65 COURT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4916
Practice Address - Country:US
Practice Address - Phone:917-226-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018034-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist