Provider Demographics
NPI:1356879001
Name:BENGYEL, LYNDA LEE (COTA)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:LEE
Last Name:BENGYEL
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 1:52 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1220
Mailing Address - Country:US
Mailing Address - Phone:908-319-8244
Mailing Address - Fax:
Practice Address - Street 1:390 RED SCHOOL LN
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2230
Practice Address - Country:US
Practice Address - Phone:908-859-0200
Practice Address - Fax:908-859-1961
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09111900224Z00000X
PAOP008192224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOP008192OtherCOTA
NJ46TA09111900OtherCOTA