Provider Demographics
NPI:1124387188
Name:MISKA, ERICA SARA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:SARA
Last Name:MISKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:SARA
Other - Last Name:MISKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:8440 101ST ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1109
Mailing Address - Country:US
Mailing Address - Phone:718-846-0454
Mailing Address - Fax:718-263-0491
Practice Address - Street 1:8440 101ST ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1109
Practice Address - Country:US
Practice Address - Phone:718-846-0454
Practice Address - Fax:718-263-0491
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013743-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist