Provider Demographics
NPI:1417192402
Name:HOROWITZ, MIRIAM MALKA (MA, OTR/L)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:MALKA
Last Name:HOROWITZ
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:MALKA
Other - Last Name:MILGRAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, OTR/L
Mailing Address - Street 1:6714 172ND ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3317
Mailing Address - Country:US
Mailing Address - Phone:718-353-1195
Mailing Address - Fax:
Practice Address - Street 1:6725 188TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3767
Practice Address - Country:US
Practice Address - Phone:718-454-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008270-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist