Provider Demographics
NPI:1396990271
Name:VALLER, NINA (OTR/L)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:VALLER
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 1:205 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14755-1251
Mailing Address - Country:US
Mailing Address - Phone:716-378-2119
Mailing Address - Fax:
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE VALLEY
Practice Address - State:NY
Practice Address - Zip Code:14755-1251
Practice Address - Country:US
Practice Address - Phone:716-378-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005264-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005264-1OtherSTATE LICENSE