Provider Demographics
NPI:1053148973
Name:CASTILLO, DENISE ALTAGRACIA (OTR/L)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ALTAGRACIA
Last Name:CASTILLO
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 1:39 FOUNTAIN PL APT 1B
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-6563
Mailing Address - Country:US
Mailing Address - Phone:914-510-3061
Mailing Address - Fax:
Practice Address - Street 1:39 FOUNTAIN PL APT 1B
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-6563
Practice Address - Country:US
Practice Address - Phone:914-510-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-11-21
Deactivation Date:2024-10-16
Deactivation Code:
Reactivation Date:2024-11-21
Provider Licenses
StateLicense IDTaxonomies
NY029402225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty