Provider Demographics
NPI:1831673243
Name:KHAIMOVA, LIANA
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:
Last Name:KHAIMOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13671 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2327
Mailing Address - Country:US
Mailing Address - Phone:917-828-3131
Mailing Address - Fax:
Practice Address - Street 1:13671 72ND AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2327
Practice Address - Country:US
Practice Address - Phone:917-828-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-12-11
Deactivation Date:2018-09-22
Deactivation Code:
Reactivation Date:2018-12-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist