Provider Demographics
NPI:1790137107
Name:JUDGE-AVALLONE, JUDITH ANN (OT, RN)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:JUDGE-AVALLONE
Suffix:
Gender:F
Credentials:OT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SOUNDVIEW DR N
Mailing Address - Street 2:
Mailing Address - City:LLOYD HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11743-9799
Mailing Address - Country:US
Mailing Address - Phone:631-425-7074
Mailing Address - Fax:
Practice Address - Street 1:21 SOUNDVIEW DR N
Practice Address - Street 2:
Practice Address - City:LLOYD HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11743-9799
Practice Address - Country:US
Practice Address - Phone:631-425-7074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004943-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics