Individual
TINA MARIE RACINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
26 WILLIS AVE, RAVENA, NY 12143-1917
(518) 312-3628
Mailing address
26 WILLIS AVE, RAVENA, NY 12143-1917
(518) 312-3628
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
003383-1
NY
Other
Enumeration date
08/29/2012
Last updated
04/22/2013
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