Provider Demographics
NPI:1144976440
Name:BADALOVA, IZOBELA (OTR/L)
Entity type:Individual
Prefix:
First Name:IZOBELA
Middle Name:
Last Name:BADALOVA
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 1:9840 64TH AVE APT 4C
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2516
Mailing Address - Country:US
Mailing Address - Phone:917-285-0583
Mailing Address - Fax:
Practice Address - Street 1:15005 70TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1420
Practice Address - Country:US
Practice Address - Phone:718-520-1324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025375-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist