Provider Demographics
NPI:1518273432
Name:GENTILE, LORRAINE A (COTA)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:A
Last Name:GENTILE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:LORRAINE
Other - Middle Name:A
Other - Last Name:BELMONTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:15703 85TH ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2620
Mailing Address - Country:US
Mailing Address - Phone:631-220-2517
Mailing Address - Fax:
Practice Address - Street 1:15703 85TH ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2620
Practice Address - Country:US
Practice Address - Phone:631-220-2517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005843-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant