Provider Demographics
NPI:1831590686
Name:CZIMBAL, CAROLYN (OT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:CZIMBAL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LITTLE DR
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-6328
Mailing Address - Country:US
Mailing Address - Phone:518-879-5797
Mailing Address - Fax:
Practice Address - Street 1:16 LITTLE DR
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-6328
Practice Address - Country:US
Practice Address - Phone:518-879-5797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013500-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics