Provider Demographics
NPI:1669715363
Name:UNGAR FISHMAN, JUDITH S (MA OTR/L)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:S
Last Name:UNGAR FISHMAN
Suffix:
Gender:F
Credentials:MA OTR/L
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:S UNGAR
Other - Last Name:FISHMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6127 W 77TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1641
Mailing Address - Country:US
Mailing Address - Phone:310-710-3767
Mailing Address - Fax:
Practice Address - Street 1:6127 W 77TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1641
Practice Address - Country:US
Practice Address - Phone:310-710-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5178225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist