Provider Demographics
NPI:1306336482
Name:TAKHALOVA OCCUPATIONAL THERAPY PLLC
Entity type:Organization
Organization Name:TAKHALOVA OCCUPATIONAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:INESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-333-1394
Mailing Address - Street 1:9949 66TH RD APT 2B
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4431
Mailing Address - Country:US
Mailing Address - Phone:631-661-3292
Mailing Address - Fax:212-208-2499
Practice Address - Street 1:143 E MAIN ST FL 1
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3524
Practice Address - Country:US
Practice Address - Phone:631-661-3292
Practice Address - Fax:212-208-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty