Provider Demographics
NPI:1245807981
Name:BLOCK, MIKAYLA (MSOTR)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MSOTR
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Other - Last Name:
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Mailing Address - Street 1:1 IRVING PL APT U25D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-9731
Mailing Address - Country:US
Mailing Address - Phone:646-761-8860
Mailing Address - Fax:
Practice Address - Street 1:1 IRVING PL APT U25D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-9731
Practice Address - Country:US
Practice Address - Phone:646-761-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics