Provider Demographics
NPI:1053150151
Name:MENSHIKOVA, YELIZAVETA (OTRL)
Entity type:Individual
Prefix:
First Name:YELIZAVETA
Middle Name:
Last Name:MENSHIKOVA
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3315
Mailing Address - Country:US
Mailing Address - Phone:347-247-7508
Mailing Address - Fax:
Practice Address - Street 1:141 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3315
Practice Address - Country:US
Practice Address - Phone:347-247-7508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029145225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist