Provider Demographics
NPI:1740580638
Name:DAGROSA, LYNNETTE MARGARET (MA,OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LYNNETTE
Middle Name:MARGARET
Last Name:DAGROSA
Suffix:
Gender:F
Credentials:MA,OTR/L
Other - Prefix:MR
Other - First Name:MATTHEW
Other - Middle Name:ANTHONY
Other - Last Name:DAGROSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:154 CARROLL ST APT D3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3540
Mailing Address - Country:US
Mailing Address - Phone:718-522-2748
Mailing Address - Fax:
Practice Address - Street 1:154 CARROLL ST APT D3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3540
Practice Address - Country:US
Practice Address - Phone:718-522-2748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0021481174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist