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General NPI Number Information
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NPI Number | 1609919984
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Entity Type | Individual
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Provider Name | MRS. BONNIE LYNN RUBELL
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Gender | Female
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1227 2 MONTAUK HIGHWAY TENDER AGE PT INC
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City | OAKDALE
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State | NY
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Zip | 11769
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Country | US
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Telephone | 631-218-1545
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Fax | 631-218-2650
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Provider Business Mailing Address
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Address Line | 562 CHESTER ROAD
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City | SAYVILLE
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State | NY
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Zip | 11782
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Country | US
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Telephone | 631-750-3382
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0021831
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License Number State | NY
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