Provider Demographics
NPI:1699914713
Name:WAXMAN SHATZKES, SHIRA (MS OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SHIRA
Middle Name:
Last Name:WAXMAN SHATZKES
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:SHIRA
Other - Middle Name:
Other - Last Name:WAXMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:6585 162ND ST
Mailing Address - Street 2:APT. 3F
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2665
Mailing Address - Country:US
Mailing Address - Phone:718-380-4063
Mailing Address - Fax:
Practice Address - Street 1:6585 162ND ST
Practice Address - Street 2:APT. 3F
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2665
Practice Address - Country:US
Practice Address - Phone:718-380-4063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014770-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist