Provider Demographics
NPI:1053667006
Name:MOMICH, CHRISTINE D (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:D
Last Name:MOMICH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 223RD ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2236
Mailing Address - Country:US
Mailing Address - Phone:718-428-5370
Mailing Address - Fax:
Practice Address - Street 1:9802 62ND DR
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1741
Practice Address - Country:US
Practice Address - Phone:718-263-1587
Practice Address - Fax:718-275-9753
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004733225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics