Provider Demographics
NPI:1548478043
Name:ALLEY, BIBI Y (COTA)
Entity type:Individual
Prefix:MS
First Name:BIBI
Middle Name:Y
Last Name:ALLEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 204TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-3026
Mailing Address - Country:US
Mailing Address - Phone:718-776-7199
Mailing Address - Fax:
Practice Address - Street 1:20507 HILLSIDE AVE
Practice Address - Street 2:SUITE 20-23
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2220
Practice Address - Country:US
Practice Address - Phone:718-264-1789
Practice Address - Fax:718-264-2179
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005809224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005809Medicaid