Provider Demographics
NPI:1992020960
Name:ADLAH, ALI M (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:M
Last Name:ADLAH
Suffix:
Gender:M
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 1:1748 WISTERIA CIR
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-3047
Mailing Address - Country:US
Mailing Address - Phone:631-774-3055
Mailing Address - Fax:631-594-1692
Practice Address - Street 1:1748 WISTERIA CIR
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-3047
Practice Address - Country:US
Practice Address - Phone:631-774-3055
Practice Address - Fax:631-594-1692
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10087225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist