Provider Demographics
NPI: | 1821681214 |
---|---|
Name: | CHRISTIAN, DENEVIA (OTR/L) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | DENEVIA |
Middle Name: | |
Last Name: | CHRISTIAN |
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: | 1319 E 91ST ST |
Mailing Address - Street 2: | |
Mailing Address - City: | BROOKLYN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11236-4213 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 347-277-0521 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 255 EXECUTIVE DR STE 105 |
Practice Address - Street 2: | |
Practice Address - City: | PLAINVIEW |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11803-1707 |
Practice Address - Country: | US |
Practice Address - Phone: | 516-576-2040 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2021-02-16 |
Last Update Date: | 2021-02-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 025145 | 225XE0001X, 225XF0002X, 225XG0600X, 225XL0004X, 225XM0800X, 225XP0019X, 225XP0200X, 225XR0403X, 225X00000X |
225XE0001X, 225XG0600X, 225XP0019X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | |
No | 225XE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing |
No | 225XG0600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology |
No | 225XL0004X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision |
No | 225XM0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Mental Health |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No | 225XR0403X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Driving and Community Mobility |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 025145 | Medicaid |