Provider Demographics
NPI:1891055273
Name:ULI, AISELA (OTR/L)
Entity Type:Individual
Prefix:
First Name:AISELA
Middle Name:
Last Name:ULI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RAVENSWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1013
Mailing Address - Country:US
Mailing Address - Phone:917-992-1097
Mailing Address - Fax:
Practice Address - Street 1:5 RAVENSWOOD CT
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1013
Practice Address - Country:US
Practice Address - Phone:917-992-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-20
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016686171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor