Provider Demographics
NPI:1386044360
Name:DEKANCHUK, CAROLYN (OTA/L)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:DEKANCHUK
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25523 MEMPHIS AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2553
Mailing Address - Country:US
Mailing Address - Phone:516-330-1206
Mailing Address - Fax:
Practice Address - Street 1:25523 MEMPHIS AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2553
Practice Address - Country:US
Practice Address - Phone:516-330-1206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0070731224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant