Provider Demographics
NPI:1932346038
Name:NUSSBAUM, DEVORAH (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:DEVORAH
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1717
Mailing Address - Country:US
Mailing Address - Phone:845-425-7166
Mailing Address - Fax:
Practice Address - Street 1:30 CONCORD DR
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1717
Practice Address - Country:US
Practice Address - Phone:845-425-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-11
Last Update Date:2009-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014174225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist