Provider Demographics
NPI:1841345154
Name:NIKIRK, IVONNE (OTR)
Entity type:Individual
Prefix:MRS
First Name:IVONNE
Middle Name:
Last Name:NIKIRK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4429
Mailing Address - Country:US
Mailing Address - Phone:631-724-3231
Mailing Address - Fax:631-724-3231
Practice Address - Street 1:164 HICKORY LN
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4429
Practice Address - Country:US
Practice Address - Phone:631-724-3231
Practice Address - Fax:631-724-3231
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000756-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist