Provider Demographics
NPI:1700354545
Name:NATHANSON, RAE ANNE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:ANNE
Last Name:NATHANSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 LIDO BLVD APT 17A
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-5200
Mailing Address - Country:US
Mailing Address - Phone:917-685-9914
Mailing Address - Fax:
Practice Address - Street 1:1723 E 12TH ST STE 5L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1071
Practice Address - Country:US
Practice Address - Phone:718-339-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022812225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist