Provider Demographics
NPI:1154525079
Name:KATZMAN, MIRIAM LISA
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:LISA
Last Name:KATZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:LISA
Other - Last Name:EISENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3616 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1902
Mailing Address - Country:US
Mailing Address - Phone:847-673-8038
Mailing Address - Fax:
Practice Address - Street 1:3716 DAVIS ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1745
Practice Address - Country:US
Practice Address - Phone:847-982-5822
Practice Address - Fax:847-982-5823
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL56004090225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist