Provider Demographics
NPI:1871811299
Name:DEREK, NINA (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:NINA
Middle Name:
Last Name:DEREK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 COMMUNITY DR APT 1J
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3840
Mailing Address - Country:US
Mailing Address - Phone:516-570-0152
Mailing Address - Fax:
Practice Address - Street 1:306 COMMUNITY DR
Practice Address - Street 2:APT # 1J
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3838
Practice Address - Country:US
Practice Address - Phone:516-570-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016152-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics