Provider Demographics
NPI:1114329620
Name:NUSSBAUM, AMY YOCHEVED (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:YOCHEVED
Last Name:NUSSBAUM
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 1:761 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2904
Mailing Address - Country:US
Mailing Address - Phone:516-770-7953
Mailing Address - Fax:
Practice Address - Street 1:761 BRYANT ST
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2904
Practice Address - Country:US
Practice Address - Phone:516-569-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019083225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist