Provider Demographics
NPI:1851903678
Name:KENNER, MENUCHAH (OTR/L)
Entity Type:Individual
Prefix:
First Name:MENUCHAH
Middle Name:
Last Name:KENNER
Suffix:
Gender:F
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 1:13 CAREFREE LN
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-2403
Mailing Address - Country:US
Mailing Address - Phone:718-614-5506
Mailing Address - Fax:
Practice Address - Street 1:13 CAREFREE LN
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-2403
Practice Address - Country:US
Practice Address - Phone:718-614-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024901225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist