Provider Demographics
NPI:1689951006
Name:IVONNE NIKIRK OT PC
Entity Type:Organization
Organization Name:IVONNE NIKIRK OT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:631-724-3231
Mailing Address - Street 1:164 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4429
Mailing Address - Country:US
Mailing Address - Phone:631-724-3231
Mailing Address - Fax:631-724-3231
Practice Address - Street 1:164 HICKORY LN
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4429
Practice Address - Country:US
Practice Address - Phone:631-724-3231
Practice Address - Fax:631-724-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000756-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty