Provider Demographics
NPI:1326498106
Name:LAMB-FREEMAN, AVA K (COTA)
Entity Type:Individual
Prefix:MRS
First Name:AVA
Middle Name:K
Last Name:LAMB-FREEMAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CORNWALL ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12520-1839
Mailing Address - Country:US
Mailing Address - Phone:631-835-1606
Mailing Address - Fax:
Practice Address - Street 1:314 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CORNWALL ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12520-1839
Practice Address - Country:US
Practice Address - Phone:631-835-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008760-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant