Provider Demographics
NPI:1699116137
Name:MANOLATOS, EFTYHIA (OTR/L)
Entity type:Individual
Prefix:MS
First Name:EFTYHIA
Middle Name:
Last Name:MANOLATOS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:EFFIE
Other - Middle Name:
Other - Last Name:MANOLATOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:215-02 23RD RD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360
Mailing Address - Country:US
Mailing Address - Phone:917-224-8535
Mailing Address - Fax:
Practice Address - Street 1:215-02 23RD RD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360
Practice Address - Country:US
Practice Address - Phone:917-224-8535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018134225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist