Provider Demographics
NPI:1639395668
Name:ACEVEDO, LOREEN (OTR)
Entity Type:Individual
Prefix:MS
First Name:LOREEN
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TERESA LN
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-6329
Mailing Address - Country:US
Mailing Address - Phone:914-329-8977
Mailing Address - Fax:
Practice Address - Street 1:401 E 76TH ST APT 2W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2531
Practice Address - Country:US
Practice Address - Phone:914-329-8977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012084225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist