Provider Demographics
NPI:1063665727
Name:OSBORNE, NINA LEIGH (MOT)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:LEIGH
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:MISS
Other - First Name:NINA
Other - Middle Name:LEIGH
Other - Last Name:MARTILLOTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:301 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-2124
Mailing Address - Country:US
Mailing Address - Phone:724-664-7138
Mailing Address - Fax:
Practice Address - Street 1:154 HINDMAN RD
Practice Address - Street 2:BUTLER
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2417
Practice Address - Country:US
Practice Address - Phone:724-282-6906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010422225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist