Provider Demographics
NPI:1689222341
Name:RUTENBER, CHRISTINA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:RUTENBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-1629
Mailing Address - Country:US
Mailing Address - Phone:607-437-3918
Mailing Address - Fax:
Practice Address - Street 1:EDMESTON CENTRAL SCHOOL
Practice Address - Street 2:11 NORTH ST.
Practice Address - City:EDMESTON
Practice Address - State:NY
Practice Address - Zip Code:13838
Practice Address - Country:US
Practice Address - Phone:607-965-8931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003165224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant