Provider Demographics
NPI:1154078343
Name:ZIMMERMAN, ILYSE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ILYSE
Middle Name:
Last Name:ZIMMERMAN
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 1:24 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-1144
Mailing Address - Country:US
Mailing Address - Phone:718-490-2065
Mailing Address - Fax:
Practice Address - Street 1:24 ORCHARD LN
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-1144
Practice Address - Country:US
Practice Address - Phone:718-490-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00469900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist