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General NPI Number Information
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NPI Number | 1710797618
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Entity Type | Individual
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Provider Name | LUNA JEAN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 77 N CENTRE AVE STE 215
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-3923
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Country | US
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Telephone | 631-363-5794
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Fax |
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Provider Business Mailing Address
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Address Line | 101 SMITH ST
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City | DEER PARK
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State | NY
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Zip | 11729-2646
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Country | US
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Telephone |
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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 | 028845
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 028845
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License Number State | NY
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