Provider Demographics
NPI:1154199784
Name:BLUMENTHAL, JOANNA (OT)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:BLUMENTHAL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-3706
Mailing Address - Country:US
Mailing Address - Phone:914-266-0582
Mailing Address - Fax:
Practice Address - Street 1:181 WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-3706
Practice Address - Country:US
Practice Address - Phone:914-266-0582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019778225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist