Provider Demographics
NPI:1417591199
Name:NEVILLE, REBECCA (OCCUPATIONAL THERAPY)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TEE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-0001
Mailing Address - Country:US
Mailing Address - Phone:631-874-3032
Mailing Address - Fax:631-874-4105
Practice Address - Street 1:302 PATCHOGUE HOBROOK RD, SUNRISE OF HOLBROOK
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741
Practice Address - Country:US
Practice Address - Phone:631-874-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYO23829-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist