Provider Demographics
NPI:1497069876
Name:CONSUEGRA, ANNETTE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:CONSUEGRA
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 1:1031 TRINITY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-6949
Mailing Address - Country:US
Mailing Address - Phone:646-648-8593
Mailing Address - Fax:
Practice Address - Street 1:1031 TRINITY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-6949
Practice Address - Country:US
Practice Address - Phone:646-648-8593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007436-1224Z00000X
NY020916225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant