Provider Demographics
NPI:1841834504
Name:NEMORIN, DAVITA ANGELINA (OTR/L)
Entity type:Individual
Prefix:
First Name:DAVITA
Middle Name:ANGELINA
Last Name:NEMORIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SUSSEX RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2034
Mailing Address - Country:US
Mailing Address - Phone:516-439-0304
Mailing Address - Fax:
Practice Address - Street 1:165 SUSSEX RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2034
Practice Address - Country:US
Practice Address - Phone:516-439-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024104225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist