Provider Demographics
NPI:1558749127
Name:BLUESTINE, ELANA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:
Last Name:BLUESTINE
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 1:130 8TH AVE
Mailing Address - Street 2:APT. 6C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1766
Mailing Address - Country:US
Mailing Address - Phone:646-246-0564
Mailing Address - Fax:
Practice Address - Street 1:130 8TH AVE
Practice Address - Street 2:APT. 6C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1766
Practice Address - Country:US
Practice Address - Phone:646-246-0564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019631225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist