Provider Demographics
NPI:1639776966
Name:CHRISTOFOROU, IRENE (OTR/L)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:CHRISTOFOROU
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 1:395 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3833
Mailing Address - Country:US
Mailing Address - Phone:631-946-2681
Mailing Address - Fax:
Practice Address - Street 1:350 PONCA PL
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-3828
Practice Address - Country:US
Practice Address - Phone:303-499-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0006535225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist