Provider Demographics
NPI:1083109516
Name:ALISHAYEVA, OLGA (OTA)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:ALISHAYEVA
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 EASTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2805
Mailing Address - Country:US
Mailing Address - Phone:718-882-2111
Mailing Address - Fax:718-882-2211
Practice Address - Street 1:2447 EASTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2805
Practice Address - Country:US
Practice Address - Phone:718-882-2111
Practice Address - Fax:718-882-2211
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008022-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherSS#