Provider Demographics
NPI:1861148967
Name:GIFFORD, DENISE MARIE (COTA)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 1ST ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-3892
Mailing Address - Country:US
Mailing Address - Phone:518-879-2937
Mailing Address - Fax:
Practice Address - Street 1:605 1ST ST APT 1
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-3892
Practice Address - Country:US
Practice Address - Phone:518-879-2937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003169-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant