Provider Demographics
NPI:1710358312
Name:BOUCHKANETS, LENA (OT)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:BOUCHKANETS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W END AVE
Mailing Address - Street 2:2M
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4848
Mailing Address - Country:US
Mailing Address - Phone:917-969-0214
Mailing Address - Fax:
Practice Address - Street 1:2 W END AVE
Practice Address - Street 2:2M
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4848
Practice Address - Country:US
Practice Address - Phone:917-969-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63020087225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist