Provider Demographics
NPI:1790974566
Name:MEJIA, LINDA E
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:E
Last Name:MEJIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:E
Other - Last Name:BLOOMQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 TEE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2939
Mailing Address - Country:US
Mailing Address - Phone:631-874-3032
Mailing Address - Fax:631-874-4105
Practice Address - Street 1:5 TEE VIEW CT
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-2939
Practice Address - Country:US
Practice Address - Phone:631-874-3032
Practice Address - Fax:631-874-4105
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010311-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist