Provider Demographics
NPI:1386282234
Name:WALDRUP, CORINA MONIKA (OT/L)
Entity type:Individual
Prefix:MRS
First Name:CORINA
Middle Name:MONIKA
Last Name:WALDRUP
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 ROUTE 100 # 106
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-3227
Mailing Address - Country:US
Mailing Address - Phone:914-597-2890
Mailing Address - Fax:914-669-5061
Practice Address - Street 1:325 ROUTE 100 # 106
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-3227
Practice Address - Country:US
Practice Address - Phone:914-597-2890
Practice Address - Fax:914-669-5061
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008445-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist