Provider Demographics
NPI:1437453214
Name:ISHMAIL, RADIAH MARIA (OTR/L, DPT)
Entity Type:Individual
Prefix:DR
First Name:RADIAH
Middle Name:MARIA
Last Name:ISHMAIL
Suffix:
Gender:F
Credentials:OTR/L, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5424
Mailing Address - Country:US
Mailing Address - Phone:347-682-1817
Mailing Address - Fax:
Practice Address - Street 1:753 CROWN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5424
Practice Address - Country:US
Practice Address - Phone:347-682-1817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012315225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist