Provider Demographics
NPI:1225282312
Name:FELDMAN, LISA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:ALIZA
Other - Middle Name:
Other - Last Name:FELDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:703 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2836
Mailing Address - Country:US
Mailing Address - Phone:917-741-3659
Mailing Address - Fax:
Practice Address - Street 1:703 EMERSON ST
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2836
Practice Address - Country:US
Practice Address - Phone:917-741-3659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-16
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011987225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist