Provider Demographics
NPI:1639533607
Name:PORTNAYA, LIKA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LIKA
Middle Name:
Last Name:PORTNAYA
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 1:464 NEPTUNE AVE
Mailing Address - Street 2:APT 3F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4332
Mailing Address - Country:US
Mailing Address - Phone:917-392-1851
Mailing Address - Fax:
Practice Address - Street 1:464 NEPTUNE AVE
Practice Address - Street 2:APT 3F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4332
Practice Address - Country:US
Practice Address - Phone:917-392-1851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63020488225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist