Provider Demographics
NPI:1376795716
Name:DEJEWSKI, NINA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:MARIE
Last Name:DEJEWSKI
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 1:46 KNOLLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-9539
Mailing Address - Country:US
Mailing Address - Phone:717-872-5104
Mailing Address - Fax:
Practice Address - Street 1:46 KNOLLWOOD RD
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17551-9539
Practice Address - Country:US
Practice Address - Phone:717-872-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006723L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist