Provider Demographics
NPI:1336443290
Name:DEGIRONIMO-TENNYSON, ANNETTE MARIA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:MARIA
Last Name:DEGIRONIMO-TENNYSON
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 1:1010 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5330
Mailing Address - Country:US
Mailing Address - Phone:315-733-3932
Mailing Address - Fax:
Practice Address - Street 1:1010 JAMES ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5330
Practice Address - Country:US
Practice Address - Phone:315-733-3932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004012-1174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator