Provider Demographics
NPI:1821222134
Name:MEDALION-YALOZ, LEEAT (OTR/L)
Entity Type:Individual
Prefix:
First Name:LEEAT
Middle Name:
Last Name:MEDALION-YALOZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LEEAT
Other - Middle Name:
Other - Last Name:MEDALION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:2820 214TH PL
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2626
Mailing Address - Country:US
Mailing Address - Phone:917-498-3034
Mailing Address - Fax:
Practice Address - Street 1:15645 84TH ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2617
Practice Address - Country:US
Practice Address - Phone:718-738-1800
Practice Address - Fax:718-848-8683
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015556225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics