Provider Demographics
NPI:1841794203
Name:PINEDA, CHANTELLE MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:MARIE
Last Name:PINEDA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 WESTCHESTER AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2500
Mailing Address - Country:US
Mailing Address - Phone:914-305-5345
Mailing Address - Fax:
Practice Address - Street 1:2975 WESTCHESTER AVE STE 202
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2500
Practice Address - Country:US
Practice Address - Phone:914-305-5345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009662224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant