Provider Demographics
NPI:1508473661
Name:OESTRICHER-NIEVES, OCTAVIA (SLP-CF / TSSLD)
Entity Type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:
Last Name:OESTRICHER-NIEVES
Suffix:
Gender:F
Credentials:SLP-CF / TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6707
Mailing Address - Country:US
Mailing Address - Phone:212-634-2803
Mailing Address - Fax:
Practice Address - Street 1:59 OLD SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-6123
Practice Address - Country:US
Practice Address - Phone:845-634-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1423069202390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program