Provider Demographics
NPI:1902052764
Name:RUBIN, LISE D (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISE
Middle Name:D
Last Name:RUBIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BENNETT AVE
Mailing Address - Street 2:APT. C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-2308
Mailing Address - Country:US
Mailing Address - Phone:312-972-0109
Mailing Address - Fax:
Practice Address - Street 1:110 BENNETT AVE
Practice Address - Street 2:APT. C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2308
Practice Address - Country:US
Practice Address - Phone:312-972-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.006723225X00000X
NY001374225X00000X
MAAH 355225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist