Provider Demographics
NPI:1598046898
Name:FISHBAUM, YAEL (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:YAEL
Middle Name:
Last Name:FISHBAUM
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:YAEL
Other - Middle Name:
Other - Last Name:NEVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:915 E 17TH ST
Mailing Address - Street 2:APT 102
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3750
Mailing Address - Country:US
Mailing Address - Phone:718-252-3078
Mailing Address - Fax:
Practice Address - Street 1:915 E 17TH ST
Practice Address - Street 2:APT 102
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3750
Practice Address - Country:US
Practice Address - Phone:718-252-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014990225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist