Provider Demographics
NPI:1396021408
Name:MAIMAN, ALTHEA Z
Entity Type:Individual
Prefix:MRS
First Name:ALTHEA
Middle Name:Z
Last Name:MAIMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALTHEA
Other - Middle Name:LYNNE
Other - Last Name:MAIMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:35 WILMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4032
Mailing Address - Country:US
Mailing Address - Phone:631-491-1130
Mailing Address - Fax:
Practice Address - Street 1:2351 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1822
Practice Address - Country:US
Practice Address - Phone:516-608-6339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002149-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist