Provider Demographics
NPI:1073901716
Name:DOMADIA, PAYAL (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:PAYAL
Middle Name:
Last Name:DOMADIA
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 1:2 DAWN LN
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1135
Mailing Address - Country:US
Mailing Address - Phone:516-972-0472
Mailing Address - Fax:
Practice Address - Street 1:2 DAWN LN
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1135
Practice Address - Country:US
Practice Address - Phone:516-972-0472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019304225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist