Provider Demographics
NPI:1689385635
Name:LAMBERT, TENNILLE GAEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:TENNILLE
Middle Name:GAEL
Last Name:LAMBERT
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 1:9 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4519
Mailing Address - Country:US
Mailing Address - Phone:646-286-9118
Mailing Address - Fax:
Practice Address - Street 1:15 PARK LAWN DR UNIT B
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1041
Practice Address - Country:US
Practice Address - Phone:203-790-8520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5992225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist