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Contact Information

MIRA GOLDIS WACHSTOCK, MA, OTR/L
19614 POMPEII AVE
HOLLIS, NY11423-1418
 Phone: 718-464-0709
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

225XP0200X 67 Occupational Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for MIRA GOLDIS WACHSTOCK · (Female)

NPI Number 1881834810
Status Active
Credentials MA, OTR/L
Entity Individual
Enumeration date 03/04/2009
Last updated 03/04/2009 - About 17 years ago
Sole proprietor 1 Yes
Identifiers
  • NY License # 010633-1
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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