Provider Demographics
NPI:1285901330
Name:NUGENT, CHRISTINE MARY (OTR)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARY
Last Name:NUGENT
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 1:51 OLD DOCK RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2613
Mailing Address - Country:US
Mailing Address - Phone:631-662-6107
Mailing Address - Fax:
Practice Address - Street 1:51 OLD DOCK RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-2613
Practice Address - Country:US
Practice Address - Phone:631-662-6107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003652225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003652OtherOT LICENSE