Healthcare Provider Details

I. General information

NPI: 1972851087
Provider Name (Legal Business Name): OCCUPATIONAL THERAPY BY MIRIAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 E 19TH ST
BROOKLYN NY
11230-6716
US

IV. Provider business mailing address

1434 E 19TH ST
BROOKLYN NY
11230-6716
US

V. Phone/Fax

Practice location:
  • Phone: 718-755-3218
  • Fax: 718-336-2775
Mailing address:
  • Phone: 718-755-3218
  • Fax: 718-336-2775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number007517-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIANNA KARIYEV
Title or Position: OWNER
Credential: OTR/L
Phone: 718-755-3218