MEDICARE: DR. RADIAH MARIA ISHMAIL OTR/L, DPT

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	012315	NY

General Provider Information

NPI Number	:	1437453214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RADIAH MARIA ISHMAIL OTR/L, DPT

Provider Business Mailing Address
First Line	:	753 CROWN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-5424
Country	:	US
Telephone Number	:	347-682-1817
Fax Number	:

Provider Business Practice Location Address
First Line	:	753 CROWN ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11213-5424
Country	:	US
Telephone Number	:	347-682-1817
Fax Number	:

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

Provider Enumeration Date	:	01/07/2011
Last Update Date	:	01/07/2011

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