Provider Demographics
NPI:1740517762
Name:WALJOB- HARRY, QUEEN REBECCA
Entity type:Individual
Prefix:MRS
First Name:QUEEN
Middle Name:REBECCA
Last Name:WALJOB- HARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:QUEEN
Other - Middle Name:REBECCA
Other - Last Name:WALJOB-HARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:9115 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3932
Mailing Address - Country:US
Mailing Address - Phone:718-272-4424
Mailing Address - Fax:
Practice Address - Street 1:9115 AVENUE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3932
Practice Address - Country:US
Practice Address - Phone:718-272-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6099834225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist