Provider Demographics
NPI:1700234317
Name:LAUTMAN, TALIA (OTR)
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:LAUTMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 W 187TH ST
Mailing Address - Street 2:APT 3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-1513
Mailing Address - Country:US
Mailing Address - Phone:516-672-6589
Mailing Address - Fax:
Practice Address - Street 1:490 W 187TH ST
Practice Address - Street 2:APT 3C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-1513
Practice Address - Country:US
Practice Address - Phone:516-672-6589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020528225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist