Provider Demographics
NPI:1265968077
Name:DAVIDOV, ELIZABETH (OTR/L)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:DAVIDOV
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 1:10510 62ND RD
Mailing Address - Street 2:APT. 5R
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1137
Mailing Address - Country:US
Mailing Address - Phone:347-599-8012
Mailing Address - Fax:
Practice Address - Street 1:10510 62ND RD
Practice Address - Street 2:APT. 5R
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1137
Practice Address - Country:US
Practice Address - Phone:347-599-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021479225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist