Provider Demographics
NPI:1730456161
Name:POPTANICH, JUDITH ANN (OTR)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:POPTANICH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:341 HIGHLAND AVE EXT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4437
Mailing Address - Country:US
Mailing Address - Phone:845-895-7200
Mailing Address - Fax:845-895-8079
Practice Address - Street 1:48 MILL ST
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-2803
Practice Address - Country:US
Practice Address - Phone:845-895-7200
Practice Address - Fax:845-564-8098
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003224-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist