Provider Demographics
NPI:1407180565
Name:TERRA CARE OT, PC
Entity Type:Organization
Organization Name:TERRA CARE OT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KITAYCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:732-252-9335
Mailing Address - Street 1:39 SHIRA LN
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8802
Mailing Address - Country:US
Mailing Address - Phone:732-252-9335
Mailing Address - Fax:
Practice Address - Street 1:1659 78TH ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1011
Practice Address - Country:US
Practice Address - Phone:718-234-1212
Practice Address - Fax:718-234-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014207225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty