Provider Demographics
NPI:1508302613
Name:MARCINKO, CHRISTINA (MOTR/L)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MARCINKO
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PERRY DR
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-4214
Mailing Address - Country:US
Mailing Address - Phone:860-488-4107
Mailing Address - Fax:
Practice Address - Street 1:15 RESEARCH DR
Practice Address - Street 2:UNIT 1
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2356
Practice Address - Country:US
Practice Address - Phone:203-387-1401
Practice Address - Fax:203-387-1415
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4684225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist