Provider Demographics
NPI:1376779462
Name:MIZRACHI, KAREN B (OT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:B
Last Name:MIZRACHI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 VINCENT AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4022
Mailing Address - Country:US
Mailing Address - Phone:203-536-0279
Mailing Address - Fax:
Practice Address - Street 1:22 VINCENT AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-4022
Practice Address - Country:US
Practice Address - Phone:203-536-0279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012569171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor