Provider Demographics
NPI:1215682547
Name:ROBERTI, JOAN KATHLEEN (OTR/L)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:KATHLEEN
Last Name:ROBERTI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 PETTIT AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2606
Mailing Address - Country:US
Mailing Address - Phone:516-477-8667
Mailing Address - Fax:
Practice Address - Street 1:11701 84TH AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1420
Practice Address - Country:US
Practice Address - Phone:718-441-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026554225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist