Provider Demographics
NPI:1336684497
Name:COHEN, LYNZEEROSE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LYNZEEROSE
Middle Name:
Last Name:COHEN
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 1:253 PURDY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4482
Mailing Address - Country:US
Mailing Address - Phone:917-251-1860
Mailing Address - Fax:
Practice Address - Street 1:253 PURDY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4482
Practice Address - Country:US
Practice Address - Phone:917-251-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021061225X00000X
NJ46TY00764600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist