Provider Demographics
NPI:1306361480
Name:LINDENBAUM, PENINA (OTR/L)
Entity Type:Individual
Prefix:
First Name:PENINA
Middle Name:
Last Name:LINDENBAUM
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 1:20 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5664
Mailing Address - Country:US
Mailing Address - Phone:646-709-6946
Mailing Address - Fax:
Practice Address - Street 1:3502 SCOTTS LN STE 711
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1561
Practice Address - Country:US
Practice Address - Phone:610-227-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015167225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist