Provider Demographics
NPI:1629608237
Name:SHAMUELOVA, ROZA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ROZA
Middle Name:
Last Name:SHAMUELOVA
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 1:6565 BOOTH ST APT 402
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4139
Mailing Address - Country:US
Mailing Address - Phone:347-639-3151
Mailing Address - Fax:
Practice Address - Street 1:6565 BOOTH ST APT 402
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4139
Practice Address - Country:US
Practice Address - Phone:347-639-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024384225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist