Provider Demographics
NPI:1861637670
Name:EBNER-RANKIN, CHARLENE (OT)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:EBNER-RANKIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 BARDONIA RD
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2106
Mailing Address - Country:US
Mailing Address - Phone:845-623-7839
Mailing Address - Fax:
Practice Address - Street 1:241 BARDONIA RD
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-2106
Practice Address - Country:US
Practice Address - Phone:845-623-7839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015411-1225X00000X
NJ46TR00483900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist