Provider Demographics
NPI:1750403671
Name:ROLDAN, MARIA LOURDES ORLANES (OTR)
Entity type:Individual
Prefix:MISS
First Name:MARIA LOURDES
Middle Name:ORLANES
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 60TH PL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2531
Mailing Address - Country:US
Mailing Address - Phone:646-464-4342
Mailing Address - Fax:
Practice Address - Street 1:6512 60TH PL
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-2531
Practice Address - Country:US
Practice Address - Phone:646-464-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014273-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist