Provider Demographics
NPI:1558506121
Name:REITEN, NINA SAMAHA (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:SAMAHA
Last Name:REITEN
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:BOICEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12412-0600
Mailing Address - Country:US
Mailing Address - Phone:845-750-1146
Mailing Address - Fax:
Practice Address - Street 1:4166 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:BOICEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12412-5203
Practice Address - Country:US
Practice Address - Phone:845-750-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013620-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist