Provider Demographics
NPI:1023643368
Name:LUSTERMAN, TALIA YOCHEVED (OTR/L)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:YOCHEVED
Last Name:LUSTERMAN
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 1:2 MAPLE RIDGE DR UNIT 12
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-7201
Mailing Address - Country:US
Mailing Address - Phone:516-503-7449
Mailing Address - Fax:
Practice Address - Street 1:1071 VARNUM AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-1131
Practice Address - Country:US
Practice Address - Phone:978-446-1862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2888225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist