Provider Demographics
NPI:1902452733
Name:DURANTE, OLIVIA KATHERINE (MSOTR/L)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:KATHERINE
Last Name:DURANTE
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ELLSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2501
Mailing Address - Country:US
Mailing Address - Phone:646-392-5174
Mailing Address - Fax:
Practice Address - Street 1:232 BARLOW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1503
Practice Address - Country:US
Practice Address - Phone:646-392-5174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023770225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist