Provider Demographics
NPI:1770369084
Name:CHARIDEMOU, REBECCA (OTD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CHARIDEMOU
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15039 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1208
Mailing Address - Country:US
Mailing Address - Phone:718-640-8306
Mailing Address - Fax:
Practice Address - Street 1:15039 7TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1208
Practice Address - Country:US
Practice Address - Phone:718-640-8306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist