Provider Demographics
NPI:1225572332
Name:DONATACCIO, CHRISTINA JEAN (COTA/L)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:JEAN
Last Name:DONATACCIO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
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Mailing Address - Street 1:1447 BROADWAY
Mailing Address - Street 2:2L
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4529
Mailing Address - Country:US
Mailing Address - Phone:727-534-8684
Mailing Address - Fax:
Practice Address - Street 1:236 2ND AVE
Practice Address - Street 2:SUIT 401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2704
Practice Address - Country:US
Practice Address - Phone:212-683-8905
Practice Address - Fax:212-683-8906
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009156-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant