Provider Demographics
NPI:1528333663
Name:DAVIDOVICH, ARIELLA MIRIAM (MS,OTR/L)
Entity type:Individual
Prefix:MS
First Name:ARIELLA
Middle Name:MIRIAM
Last Name:DAVIDOVICH
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 OCEAN PKWY
Mailing Address - Street 2:APT 6A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5660
Mailing Address - Country:US
Mailing Address - Phone:732-887-4239
Mailing Address - Fax:
Practice Address - Street 1:1400 BENSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3712
Practice Address - Country:US
Practice Address - Phone:718-236-5447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016472225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist