Provider Demographics
NPI:1265795561
Name:CAPPELLINO-FERRA, JEANANN (COTA)
Entity type:Individual
Prefix:MS
First Name:JEANANN
Middle Name:
Last Name:CAPPELLINO-FERRA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 HIMROD ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1480
Mailing Address - Country:US
Mailing Address - Phone:718-440-6500
Mailing Address - Fax:
Practice Address - Street 1:1723 HIMROD ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1480
Practice Address - Country:US
Practice Address - Phone:718-440-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004179-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY978584884Medicaid
NY978584884Medicaid