Provider Demographics
NPI:1760920227
Name:RUTHERFORD, NATASHA
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:BURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:26 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-4507
Mailing Address - Country:US
Mailing Address - Phone:917-225-4202
Mailing Address - Fax:
Practice Address - Street 1:18 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-5004
Practice Address - Country:US
Practice Address - Phone:917-215-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63 014611225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist