Provider Demographics
NPI:1649714783
Name:LIEBOWITZ, NATHALIE JAE COLMENARES (COTA/L)
Entity type:Individual
Prefix:
First Name:NATHALIE JAE
Middle Name:COLMENARES
Last Name:LIEBOWITZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:NATHALIE JAE
Other - Middle Name:COLMENARES
Other - Last Name:LARRACAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5314 94TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4632
Mailing Address - Country:US
Mailing Address - Phone:347-209-7567
Mailing Address - Fax:
Practice Address - Street 1:4277 65TH PL
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5054
Practice Address - Country:US
Practice Address - Phone:718-429-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2017-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009334224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant