Provider Demographics
NPI:1306370861
Name:SPELLMAN, NATALIE NICOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:NICOLE
Last Name:SPELLMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:NICOLE
Other - Last Name:SHAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1 TOWN HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1160
Mailing Address - Country:US
Mailing Address - Phone:760-212-5717
Mailing Address - Fax:
Practice Address - Street 1:1 TOWN HOUSE DR
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PK
Practice Address - State:NY
Practice Address - Zip Code:11762-1160
Practice Address - Country:US
Practice Address - Phone:760-212-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015905-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist