Individual
IRENE DAVIDOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
137-03 73 TERRACE, SAME AS ABOVE, FLUSHING, NY 11367
(917) 575-0527
Mailing address
137-03 73 TERRACE, SAME AS ABOVE, FLUSHING, NY 11367
(917) 575-0527
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
026799-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026799-01
REGISTRATION CERTIFICATE
NY
Enumeration date
07/08/2022
Last updated
07/08/2022
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