Provider Demographics
NPI:1497047260
Name:ROYAL, PETRONA ELIZABETH (COTA)
Entity Type:Individual
Prefix:MISS
First Name:PETRONA
Middle Name:ELIZABETH
Last Name:ROYAL
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 1:19 BENTLEY RD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1703
Mailing Address - Country:US
Mailing Address - Phone:631-278-3932
Mailing Address - Fax:
Practice Address - Street 1:19 BENTLEY RD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1703
Practice Address - Country:US
Practice Address - Phone:631-278-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1073084224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty