Provider Demographics
NPI:1336862655
Name:PRENTICE, SANDRA C
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11127 167TH ST # 11434
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-3911
Mailing Address - Country:US
Mailing Address - Phone:347-475-7085
Mailing Address - Fax:
Practice Address - Street 1:11127 167TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-3911
Practice Address - Country:US
Practice Address - Phone:347-475-7085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP117990225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist