Provider Demographics
NPI:1801259312
Name:ESPINOZA, FREDY (COTA)
Entity type:Individual
Prefix:
First Name:FREDY
Middle Name:
Last Name:ESPINOZA
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3952 3RD AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-8193
Mailing Address - Country:US
Mailing Address - Phone:347-866-3250
Mailing Address - Fax:
Practice Address - Street 1:3952 3RD AVE APT 404
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-8193
Practice Address - Country:US
Practice Address - Phone:347-866-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008922224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant