Provider Demographics
NPI:1134364292
Name:DODDS-LISS, CAROL (OTR)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:DODDS-LISS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 250TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-2405
Mailing Address - Country:US
Mailing Address - Phone:718-347-9157
Mailing Address - Fax:
Practice Address - Street 1:8115 164TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1118
Practice Address - Country:US
Practice Address - Phone:718-380-3000
Practice Address - Fax:718-380-3214
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000849225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist