Individual
MIRA GOLDIS WACHSTOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, OTR/L
Contact information
Practice address
19614 POMPEII AVE, HOLLIS, NY 11423-1418
(718) 464-0709
Mailing address
19614 POMPEII AVE, HOLLIS, NY 11423-1418
(718) 464-0709
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
010633-1
NY
Other
Enumeration date
03/04/2009
Last updated
03/04/2009
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