Provider Demographics
NPI:1386943447
Name:GOLDSTEIN, TAL B (OTR/L)
Entity type:Individual
Prefix:
First Name:TAL
Middle Name:B
Last Name:GOLDSTEIN
Suffix:
Gender:F
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 1:6524 N SACRAMENTO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4213
Mailing Address - Country:US
Mailing Address - Phone:773-338-1819
Mailing Address - Fax:
Practice Address - Street 1:540 FORT WASHINGTON AVE APT 4A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2052
Practice Address - Country:US
Practice Address - Phone:773-759-9512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016463225X00000X
IL056.009209225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist