Provider Demographics
NPI:1831522556
Name:AL-KHALIFA, SHEIKHA NOORA ROSE (OTR)
Entity type:Individual
Prefix:
First Name:SHEIKHA NOORA
Middle Name:ROSE
Last Name:AL-KHALIFA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:LYNN
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:168 IRVING AVE
Mailing Address - Street 2:SUITE 402A
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4144
Mailing Address - Country:US
Mailing Address - Phone:914-939-3143
Mailing Address - Fax:914-939-3120
Practice Address - Street 1:141 NORTH RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1037
Practice Address - Country:US
Practice Address - Phone:914-939-3143
Practice Address - Fax:914-939-3120
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002317-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist