Provider Demographics
NPI:1467094326
Name:NATELSON, ILYSSA FAITH (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ILYSSA
Middle Name:FAITH
Last Name:NATELSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5425
Mailing Address - Country:US
Mailing Address - Phone:914-329-7821
Mailing Address - Fax:
Practice Address - Street 1:19 RIDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5425
Practice Address - Country:US
Practice Address - Phone:914-329-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016647225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics