Healthcare Provider Details

I. General information

NPI: 1295048940
Provider Name (Legal Business Name): DEBRA TOVAH MACHLIS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13651 72ND AVE
FLUSHING NY
11367-2327
US

IV. Provider business mailing address

13651 72ND AVE
FLUSHING NY
11367-2327
US

V. Phone/Fax

Practice location:
  • Phone: 718-263-0439
  • Fax:
Mailing address:
  • Phone: 718-263-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number014984
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number014984
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: