Provider Demographics
NPI:1760245336
Name:INTEMANN, JOHN TRISTAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TRISTAN
Last Name:INTEMANN
Suffix:
Gender:M
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 1:387 BROOKTONDALE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:14817-9750
Mailing Address - Country:US
Mailing Address - Phone:607-342-1558
Mailing Address - Fax:
Practice Address - Street 1:387 BROOKTONDALE RD
Practice Address - Street 2:
Practice Address - City:BROOKTONDALE
Practice Address - State:NY
Practice Address - Zip Code:14817-9750
Practice Address - Country:US
Practice Address - Phone:607-342-1558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028781225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist