Provider Demographics
NPI:1710255708
Name:KHOTUNITSKAYA, NATALIA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:KHOTUNITSKAYA
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 1:119 LANGHAM ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2301
Mailing Address - Country:US
Mailing Address - Phone:347-374-5856
Mailing Address - Fax:
Practice Address - Street 1:119 LANGHAM ST FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2301
Practice Address - Country:US
Practice Address - Phone:347-374-5856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017118-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist