Provider Demographics
NPI:1417619990
Name:SIMKHAYEVA, LYUBA (OTR/L)
Entity Type:Individual
Prefix:
First Name:LYUBA
Middle Name:
Last Name:SIMKHAYEVA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:LYUBA
Other - Middle Name:
Other - Last Name:SIMKHAYEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3510 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5444
Mailing Address - Country:US
Mailing Address - Phone:718-685-8947
Mailing Address - Fax:
Practice Address - Street 1:1651 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5849
Practice Address - Country:US
Practice Address - Phone:718-962-0946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026070225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist