Provider Demographics
NPI:1467683946
Name:COSGROVE, CHRISTY L (MSOT)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14516 GLOBAL CIR APT 3208
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-5116
Mailing Address - Country:US
Mailing Address - Phone:973-903-4740
Mailing Address - Fax:
Practice Address - Street 1:14516 GLOBAL CIR APT 3208
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-5116
Practice Address - Country:US
Practice Address - Phone:973-903-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-02
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18803225X00000X
CT48.004871225X00000X
NJ46TR00457800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TR00457800OtherNJ OT COUNCIL