Provider Demographics
NPI:1417258310
Name:GALVEZ, LIZA IBASCO (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:LIZA
Middle Name:IBASCO
Last Name:GALVEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:LIZA
Other - Middle Name:IBASCO
Other - Last Name:GALVEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:12 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4516
Mailing Address - Country:US
Mailing Address - Phone:718-448-0912
Mailing Address - Fax:
Practice Address - Street 1:12 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4516
Practice Address - Country:US
Practice Address - Phone:718-448-0912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003987-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist