Provider Demographics
NPI:1629474317
Name:TERRIL, ANN-ALISA MARIE
Entity Type:Individual
Prefix:
First Name:ANN-ALISA
Middle Name:MARIE
Last Name:TERRIL
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 1:24 LEVERICH ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-5130
Mailing Address - Country:US
Mailing Address - Phone:516-410-9349
Mailing Address - Fax:
Practice Address - Street 1:24 LEVERICH ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-5130
Practice Address - Country:US
Practice Address - Phone:516-410-9349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019264225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist