Provider Demographics
NPI:1790236156
Name:MIZRAHI, BARBARA ANN (OT/RL)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANN
Last Name:MIZRAHI
Suffix:
Gender:F
Credentials:OT/RL
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:HIEDEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3531 GUILFORD CENTER RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05301-8711
Mailing Address - Country:US
Mailing Address - Phone:802-254-9259
Mailing Address - Fax:
Practice Address - Street 1:3531 GUILFORD CENTER RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:VT
Practice Address - Zip Code:05301-8711
Practice Address - Country:US
Practice Address - Phone:802-254-9259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072.0103363251S00000X
MA12094252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251S00000XAgenciesCommunity/Behavioral Health