Healthcare Provider Details

I. General information

NPI: 1811656986
Provider Name (Legal Business Name): LORI MARIE PERNAL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 PHILIPS PKWY
MONTVALE NJ
07645-1811
US

IV. Provider business mailing address

108 S BROADWAY APT E
NYACK NY
10960-4413
US

V. Phone/Fax

Practice location:
  • Phone: 917-826-1847
  • Fax:
Mailing address:
  • Phone: 917-826-1847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number023755
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number108646
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number025740
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number005956
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number439555
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number46TR01000800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: