Provider Demographics
NPI:1982313342
Name:MISIKOFF, MAYA (RN, OTR)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:MISIKOFF
Suffix:
Gender:F
Credentials:RN, OTR
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2722 HIDDEN WATERS CIR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2722 HIDDEN WATERS CIR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8520
Practice Address - Country:US
Practice Address - Phone:919-395-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC349627163W00000X
NC15534225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse