Provider Demographics
NPI:1215477500
Name:MAISCH, MICHAEL (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MAISCH
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 28TH AVE APT 12A
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2927
Mailing Address - Country:US
Mailing Address - Phone:508-404-8145
Mailing Address - Fax:
Practice Address - Street 1:4107 28TH AVE APT 12A
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2927
Practice Address - Country:US
Practice Address - Phone:508-404-8145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021276225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist