Provider Demographics
NPI:1073828281
Name:GDOVIN, NATASHA MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:MARIE
Last Name:GDOVIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:NATASHA
Other - Middle Name:MARIE
Other - Last Name:PRIBISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:236 BURTS RD
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:13795-1731
Mailing Address - Country:US
Mailing Address - Phone:877-426-3307
Mailing Address - Fax:877-426-3307
Practice Address - Street 1:236 BURTS RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:NY
Practice Address - Zip Code:13795-1731
Practice Address - Country:US
Practice Address - Phone:877-426-3307
Practice Address - Fax:877-426-3307
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014070-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist