Provider Demographics
NPI:1871938472
Name:GONNELLA, LINDSAY J (OTRL)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:J
Last Name:GONNELLA
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:J
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:583 NUTLEY PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3027
Mailing Address - Country:US
Mailing Address - Phone:516-280-0641
Mailing Address - Fax:
Practice Address - Street 1:583 NUTLEY PL
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3027
Practice Address - Country:US
Practice Address - Phone:516-280-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018007225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist