Provider Demographics
NPI:1689829962
Name:KLASS, ILENE R (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ILENE
Middle Name:R
Last Name:KLASS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4237
Mailing Address - Country:US
Mailing Address - Phone:718-252-2291
Mailing Address - Fax:718-252-2291
Practice Address - Street 1:7103 AVENUE T
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6244
Practice Address - Country:US
Practice Address - Phone:718-763-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-30
Last Update Date:2008-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013962-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist