Provider Demographics
NPI:1396373031
Name:COCCHIOLA, LIANNA JULIE
Entity Type:Individual
Prefix:
First Name:LIANNA
Middle Name:JULIE
Last Name:COCCHIOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 30TH AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2912
Mailing Address - Country:US
Mailing Address - Phone:516-314-5851
Mailing Address - Fax:
Practice Address - Street 1:6111 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4965
Practice Address - Country:US
Practice Address - Phone:718-205-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024606225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist