Provider Demographics
NPI:1083184220
Name:CHUYKO, NINA (COTA)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:CHUYKO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 E 19TH ST APT 3J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7215
Mailing Address - Country:US
Mailing Address - Phone:917-733-9468
Mailing Address - Fax:
Practice Address - Street 1:1580 E 19TH ST APT 3J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7215
Practice Address - Country:US
Practice Address - Phone:917-733-9468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007753224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty