MEDICARE: MIRIAM TAUBENFELD OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	014739	NY
2	225XP0200X	Pediatric Occupational Therapist	014739	NY

General Provider Information

NPI Number	:	1679718423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM TAUBENFELD OTR/L

Provider Business Mailing Address
First Line	:	1122 WESTWOOD RD
Second Line	:
City	:	HEWLETT
State	:	NY
Zip	:	11557-1117
Country	:	US
Telephone Number	:	516-596-7955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1854 CORNAGA AVE
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4304
Country	:	US
Telephone Number	:	718-471-5854
Fax Number	:	718-327-1453

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	12/09/2008

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