Provider Demographics
NPI:1043234982
Name:HUFFINE, VAN I (OT)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:
Last Name:HUFFINE
Suffix:I
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:10787 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46307-7615
Practice Address - Country:US
Practice Address - Phone:219-333-5900
Practice Address - Fax:219-359-2123
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006795225X00000X
IN31003369A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN31003369AMedicare ID - Type UnspecifiedOCCUPATIONAL THERAPIST
IN221850AMedicare ID - Type Unspecified