Provider Demographics
NPI:1760635528
Name:KOTORAC, RITA ERLBAUM (SLP)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:ERLBAUM
Last Name:KOTORAC
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 MITCHELL DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2212
Mailing Address - Country:US
Mailing Address - Phone:845-268-8001
Mailing Address - Fax:
Practice Address - Street 1:485 MITCHELL DR
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2212
Practice Address - Country:US
Practice Address - Phone:845-268-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK004078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist