Provider Demographics
NPI:1669604328
Name:RIBARICH, DENISE JEAN (OTR)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:JEAN
Last Name:RIBARICH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:JEAN
Other - Last Name:BRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2 ROOSEVELT AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3064
Mailing Address - Country:US
Mailing Address - Phone:631-742-6100
Mailing Address - Fax:
Practice Address - Street 1:2 ROOSEVELT AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3064
Practice Address - Country:US
Practice Address - Phone:631-742-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004498-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004498-1OtherOCCUPATIONAL THERAPY LICENSE NUMBER