Provider Demographics
NPI:1508263211
Name:BERNARD, LAURA MARQUE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MARQUE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MARQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 50385
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3018
Mailing Address - Country:US
Mailing Address - Phone:646-207-9661
Mailing Address - Fax:
Practice Address - Street 1:3391 RICHMOND AVENUE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312
Practice Address - Country:US
Practice Address - Phone:718-608-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028037225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist