MEDICARE: TENNILLE GAEL LAMBERT OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5992	CT

General Provider Information

NPI Number	:	1689385635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENNILLE GAEL LAMBERT OTR/L

Provider Business Mailing Address
First Line	:	9 HILLCREST RD
Second Line	:
City	:	BRONXVILLE
State	:	NY
Zip	:	10708-4519
Country	:	US
Telephone Number	:	646-286-9118
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 PARK LAWN DR UNIT B
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-1041
Country	:	US
Telephone Number	:	203-790-8520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	12/12/2022

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