Provider Demographics
NPI:1588147052
Name:JENNINGS PULIDO, CLEOPATA (COTA)
Entity type:Individual
Prefix:
First Name:CLEOPATA
Middle Name:
Last Name:JENNINGS PULIDO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:CLEOPATRA
Other - Middle Name:CHERICE
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:29 TOBINS LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:10928-1927
Mailing Address - Country:US
Mailing Address - Phone:845-597-9808
Mailing Address - Fax:
Practice Address - Street 1:11 WILBUR RD
Practice Address - Street 2:
Practice Address - City:THIELLS
Practice Address - State:NY
Practice Address - Zip Code:10984-7555
Practice Address - Country:US
Practice Address - Phone:845-947-6204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007167224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant