Provider Demographics
NPI:1083831705
Name:WEINRAUB, DVORA L (MS, OTR L)
Entity Type:Individual
Prefix:MISS
First Name:DVORA
Middle Name:L
Last Name:WEINRAUB
Suffix:
Gender:F
Credentials:MS, OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 BEACH 12TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4707
Mailing Address - Country:US
Mailing Address - Phone:917-826-7212
Mailing Address - Fax:718-471-1090
Practice Address - Street 1:1131 BEACH 12TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4707
Practice Address - Country:US
Practice Address - Phone:917-826-7212
Practice Address - Fax:718-471-1090
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010417225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist