Provider Demographics
NPI:1619368164
Name:DIMOPOULOS, TINA ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:ANN
Last Name:DIMOPOULOS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:ANN
Other - Last Name:DIMOPOULOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:401 E 74TH ST APT 10H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3930
Mailing Address - Country:US
Mailing Address - Phone:562-881-6895
Mailing Address - Fax:
Practice Address - Street 1:153 E 87TH ST APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2701
Practice Address - Country:US
Practice Address - Phone:212-472-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT16843225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist