Provider Demographics
NPI:1528376761
Name:NUNZIATA, THERESA (OTA)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:NUNZIATA
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 N WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-3452
Mailing Address - Country:US
Mailing Address - Phone:516-798-4507
Mailing Address - Fax:
Practice Address - Street 1:850 N WEST BLVD
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-3452
Practice Address - Country:US
Practice Address - Phone:516-798-4507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001754-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist