Provider Demographics
NPI:1154656650
Name:SIERS, ILYSSE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ILYSSE
Middle Name:
Last Name:SIERS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15611 AGUILAR AVE
Mailing Address - Street 2:APT. 3P
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2732
Mailing Address - Country:US
Mailing Address - Phone:917-741-6096
Mailing Address - Fax:
Practice Address - Street 1:15611 AGUILAR AVE
Practice Address - Street 2:APT. 3P
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2732
Practice Address - Country:US
Practice Address - Phone:917-741-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001595-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant