Provider Demographics
NPI:1366680399
Name:ROSENFELD, ANN MICHELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MICHELLE
Last Name:ROSENFELD
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 1:15 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-2109
Mailing Address - Country:US
Mailing Address - Phone:631-472-9216
Mailing Address - Fax:
Practice Address - Street 1:15 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-2109
Practice Address - Country:US
Practice Address - Phone:631-472-9216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002752-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist