Provider Demographics
NPI:1306490081
Name:AZZARITO, NATALIE (OTD, OTR)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:AZZARITO
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 NOLAND PIKE
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40067-5454
Mailing Address - Country:US
Mailing Address - Phone:574-538-9523
Mailing Address - Fax:
Practice Address - Street 1:2571 S WESTLAKE DR STE 200
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-8546
Practice Address - Country:US
Practice Address - Phone:605-413-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-007494225X00000X
FLOT23457225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist