Provider Demographics
NPI:1538625165
Name:VENUTI, CHRISTINE (OTR)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:VENUTI
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 1:125 BORINQUEN PL APT 323
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4799
Mailing Address - Country:US
Mailing Address - Phone:516-458-9925
Mailing Address - Fax:
Practice Address - Street 1:125 BORINQUEN PL APT 323
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-4799
Practice Address - Country:US
Practice Address - Phone:516-458-9925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY414579Medicaid