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1780260018
MIKHAIL ILYASOV
REGO PARK, NY
NPI
1780260018
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225X00000X Occupational Therapist
(Licence: NY 025495)
Enumeration Date
2021-03-18
Last Update Date
2021-03-18
Business Address
MIKHAIL ILYASOV OTR/L
9508 QUEENS BLVD STE 1E
REGO PARK, NY 11374-1151
Phone number: 718-275-2669
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Mailing Address
MIKHAIL ILYASOV OTR/L
14765 HOOVER AVE
BRIARWOOD, NY 11435-2139
Phone number: 718-612-5634
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