Provider Demographics
NPI:1780854737
Name:IZRAELEVITZ, TERRY E (MS/OTR)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:E
Last Name:IZRAELEVITZ
Suffix:
Gender:F
Credentials:MS/OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 TOTAVI ST
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2644
Mailing Address - Country:US
Mailing Address - Phone:505-661-8878
Mailing Address - Fax:
Practice Address - Street 1:660 TOTAVI ST
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2644
Practice Address - Country:US
Practice Address - Phone:505-661-8878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM842225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist