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General NPI Number Information
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NPI Number | 1346907375
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Entity Type | Individual
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Provider Name | SHOSHANA RAIZA WIGGINS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/24/2021
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 20 ROBERT PITT DR STE 212
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City | MONSEY
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State | NY
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Zip | 10952-3340
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Country | US
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Telephone | 845-425-2299
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Fax |
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Provider Business Mailing Address
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Address Line | 40 EDISON CT APT A
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City | MONSEY
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State | NY
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Zip | 10952-1925
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Country | US
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Telephone | 404-512-9771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 026328
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License Number State | NY
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