Provider Demographics
NPI:1770977357
Name:CIMMINO, BRIAN (MS OTR/L)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:CIMMINO
Suffix:
Gender:M
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 KEELER AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-2938
Mailing Address - Country:US
Mailing Address - Phone:914-552-6129
Mailing Address - Fax:
Practice Address - Street 1:1121 KEELER AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-2938
Practice Address - Country:US
Practice Address - Phone:914-552-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0188201225X00000X
TX115784225X00000X
MA11111225X00000X
CT003745225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist