Provider Demographics
NPI:1710592324
Name:FERTIG, CHELSEA ROSE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ROSE
Last Name:FERTIG
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 1:4205 221ST ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2432
Mailing Address - Country:US
Mailing Address - Phone:718-869-1191
Mailing Address - Fax:
Practice Address - Street 1:7740 VLEIGH PL
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3360
Practice Address - Country:US
Practice Address - Phone:718-591-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023961225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist