Provider Demographics
NPI:1245633783
Name:VENEZIA, CHRISTOPHER (OTR/L)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:VENEZIA
Suffix:
Gender:M
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 1:95 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2636
Mailing Address - Country:US
Mailing Address - Phone:516-749-4233
Mailing Address - Fax:
Practice Address - Street 1:95 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTH MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2636
Practice Address - Country:US
Practice Address - Phone:516-749-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63 016410225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist