MEDICARE: LIORA EZZATPOUR OTR

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	029362	NY

General Provider Information

NPI Number	:	1891520086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIORA EZZATPOUR OTR

Provider Business Mailing Address
First Line	:	1587 E 27TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1709
Country	:	US
Telephone Number	:	917-200-4888
Fax Number	:

Provider Business Practice Location Address
First Line	:	2810 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1887
Country	:	US
Telephone Number	:	718-258-4441
Fax Number	:

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

Provider Enumeration Date	:	09/06/2024
Last Update Date	:	09/06/2024

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