Provider Demographics
NPI:1699078196
Name:FENNELL, GENEL PULST (OTR)
Entity type:Individual
Prefix:
First Name:GENEL
Middle Name:PULST
Last Name:FENNELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:GENEL
Other - Middle Name:PULST
Other - Last Name:GRANELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:8 NASH RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10560-3711
Mailing Address - Country:US
Mailing Address - Phone:914-804-5814
Mailing Address - Fax:
Practice Address - Street 1:95 BRADHURST AVE
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1637
Practice Address - Country:US
Practice Address - Phone:914-592-7138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016518225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist