Provider Demographics
NPI:1336604800
Name:INCORVAIA, NINA R
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:R
Last Name:INCORVAIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2794 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503-2870
Mailing Address - Country:US
Mailing Address - Phone:973-476-6660
Mailing Address - Fax:
Practice Address - Street 1:2794 CHEYENNE DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81503-2870
Practice Address - Country:US
Practice Address - Phone:973-476-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005809225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist