Provider Demographics
NPI:1629164843
Name:VAYSMAN, VICTORIA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:VAYSMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 BEACH 142 STR
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694
Mailing Address - Country:US
Mailing Address - Phone:347-727-2527
Mailing Address - Fax:
Practice Address - Street 1:2876 W 27TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2812
Practice Address - Country:US
Practice Address - Phone:718-265-2222
Practice Address - Fax:718-333-1023
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010346225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02810479Medicaid
NY02810479Medicaid
NYQU1481Medicare PIN