Provider Demographics
NPI:1245408202
Name:PENALVER, MADELINE ELIZABETH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:ELIZABETH
Last Name:PENALVER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:MADELINE
Other - Middle Name:ELIZABETH
Other - Last Name:ALMONTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3 TRADER LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-7510
Mailing Address - Country:US
Mailing Address - Phone:631-650-4553
Mailing Address - Fax:
Practice Address - Street 1:3 TRADER LN
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-7510
Practice Address - Country:US
Practice Address - Phone:631-650-4553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007558-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics