Provider Demographics
NPI:1275289274
Name:RUBINOV, OLENA
Entity Type:Individual
Prefix:
First Name:OLENA
Middle Name:
Last Name:RUBINOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLENA
Other - Middle Name:
Other - Last Name:TRIFONOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 VISTA LAKE DR APT 104
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-7170
Mailing Address - Country:US
Mailing Address - Phone:347-345-8751
Mailing Address - Fax:
Practice Address - Street 1:3864 SWEETEN CREEK RD
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-3136
Practice Address - Country:US
Practice Address - Phone:828-681-0904
Practice Address - Fax:828-676-2178
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14544224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant