Provider Demographics
NPI:1912151242
Name:LEDONNE, PHILIP GREGORY (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:GREGORY
Last Name:LEDONNE
Suffix:
Gender:M
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PLEASANTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-1504
Mailing Address - Country:US
Mailing Address - Phone:516-459-5932
Mailing Address - Fax:
Practice Address - Street 1:2 PLEASANTVIEW DR
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11709-1504
Practice Address - Country:US
Practice Address - Phone:516-459-5932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011958-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics