Provider Demographics
NPI:1033364807
Name:SEDRISH, IVEY LOWENFELD (OTR)
Entity Type:Individual
Prefix:MS
First Name:IVEY
Middle Name:LOWENFELD
Last Name:SEDRISH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:IVEY
Other - Middle Name:BETH
Other - Last Name:LOWENFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:965 HEWLETT DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2707
Mailing Address - Country:US
Mailing Address - Phone:516-791-1880
Mailing Address - Fax:
Practice Address - Street 1:965 HEWLETT DR
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-2707
Practice Address - Country:US
Practice Address - Phone:516-791-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002738-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist