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INGRID SUZANNE DERSTINE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTD, ORT/L

Contact information

Practice address
14366 SOMMERVILLE CT, MIDLOTHIAN, VA 23113-6838
(631) 580-5200
(631) 580-5222
Mailing address
1377 MOTOR PKWY STE 307, ISLANDIA, NY 11749-5258
(631) 580-5200
(631) 580-5222

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119008264
VA

Other

Enumeration date
09/16/2019
Last updated
09/16/2019
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