Provider Demographics
NPI:1659602365
Name:ARISTIDE, REGINE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:REGINE
Middle Name:
Last Name:ARISTIDE
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 1:90 STATE ST STE OFFICE40
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-1716
Mailing Address - Country:US
Mailing Address - Phone:646-626-4414
Mailing Address - Fax:
Practice Address - Street 1:25344 147TH RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2826
Practice Address - Country:US
Practice Address - Phone:347-387-8708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
NY014204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist