Provider Demographics
NPI:1740415330
Name:PROKOPENKO, SVETLANA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:
Last Name:PROKOPENKO
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 1:40 SHORE BLVD APT 6D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4070
Mailing Address - Country:US
Mailing Address - Phone:347-312-6385
Mailing Address - Fax:
Practice Address - Street 1:40 SHORE BLVD APT 6D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4070
Practice Address - Country:US
Practice Address - Phone:347-312-6385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015684225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics