Provider Demographics
NPI:1568968311
Name:GOLDFEDDER, NINA RAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:RAE
Last Name:GOLDFEDDER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SPRUCE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5711
Mailing Address - Country:US
Mailing Address - Phone:215-888-4275
Mailing Address - Fax:
Practice Address - Street 1:1526 LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1625
Practice Address - Country:US
Practice Address - Phone:215-546-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015388225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist