Provider Demographics
NPI:1639202567
Name:COTKIN, KALYA BERYL (OTR)
Entity Type:Individual
Prefix:MS
First Name:KALYA
Middle Name:BERYL
Last Name:COTKIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 WHITE CLOUD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3717
Mailing Address - Country:US
Mailing Address - Phone:505-573-4472
Mailing Address - Fax:505-212-0521
Practice Address - Street 1:127 BRYN MAWR DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2265
Practice Address - Country:US
Practice Address - Phone:505-573-4472
Practice Address - Fax:505-212-0521
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2098225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist