| Doctor Name: | JENNIN MARY NANGLE |
| NPI Number: | 1285017608 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 15 Borman Ct Lake Ronkonkoma, NY - 117791982 |
| Business Phone Number: | 6314842020 |
| Business Fax Number: | |
| Mailing Address: | 15 Borman Ct, LAKE RONKONKOMA |
| State: | NY |
| Postal Code: | 117791982 |
| Phone Number: | 6314842020 |
| Fax Number: | |
| NPI Enumeration Date: | 07/02/2015 |
| NPI Last Update Date: | 07/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225800000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Recreation Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A recreation therapist uses recreational activities for intervention in some physical, social or emotional behavior to bring about a desired change in that behavior and promote the growth and development of the patient. |