Provider Demographics
NPI:1063220846
Name:TABANPOUR, LEVANA (OT)
Entity type:Individual
Prefix:
First Name:LEVANA
Middle Name:
Last Name:TABANPOUR
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 E 63RD ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7778
Mailing Address - Country:US
Mailing Address - Phone:310-876-4970
Mailing Address - Fax:
Practice Address - Street 1:164 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5956
Practice Address - Country:US
Practice Address - Phone:212-737-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist