Provider Demographics
NPI:1134356850
Name:NORMATOVA, SHUSHANA (COTA)
Entity type:Individual
Prefix:PROF
First Name:SHUSHANA
Middle Name:
Last Name:NORMATOVA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9821 65TH AVE
Mailing Address - Street 2:#2D
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3453
Mailing Address - Country:US
Mailing Address - Phone:347-601-1976
Mailing Address - Fax:
Practice Address - Street 1:9821 65TH AVE
Practice Address - Street 2:#2D
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3453
Practice Address - Country:US
Practice Address - Phone:347-601-1976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-20
Last Update Date:2009-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006999-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant