Individual
ABIGAIL NISANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
10701 OTIS AVE, CORONA, NY 11368-3915
(718) 699-6071
Mailing address
14736 76TH AVE, FLUSHING, NY 11367-3118
(646) 755-5268
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
022121
NY
Other
Enumeration date
11/30/2017
Last updated
11/30/2017
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