Provider Demographics
NPI:1346907375
Name:WIGGINS, SHOSHANA RAIZA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:RAIZA
Last Name:WIGGINS
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 1:40 EDISON CT APT A
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1925
Mailing Address - Country:US
Mailing Address - Phone:404-512-9771
Mailing Address - Fax:
Practice Address - Street 1:20 ROBERT PITT DR STE 212
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3340
Practice Address - Country:US
Practice Address - Phone:845-425-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026328225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist