Provider Demographics
NPI:1477197622
Name:WOLLMAN, ATARA
Entity Type:Individual
Prefix:MRS
First Name:ATARA
Middle Name:
Last Name:WOLLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 CENTRAL AVE APT 514
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2206
Mailing Address - Country:US
Mailing Address - Phone:917-589-3526
Mailing Address - Fax:
Practice Address - Street 1:623 CENTRAL AVE APT 514
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2206
Practice Address - Country:US
Practice Address - Phone:917-589-3526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist