Provider Demographics
NPI:1336414887
Name:HORNUNG RUDOLPH, TERRY MARIA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:MARIA
Last Name:HORNUNG RUDOLPH
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 1:11135 75TH RD
Mailing Address - Street 2:PH
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6307
Mailing Address - Country:US
Mailing Address - Phone:718-575-9754
Mailing Address - Fax:
Practice Address - Street 1:17410 67TH AVE
Practice Address - Street 2:ROOM 209
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2031
Practice Address - Country:US
Practice Address - Phone:718-358-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011934-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist