Provider Demographics
NPI:1821230517
Name:OMELKINA, ALINA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ALINA
Middle Name:
Last Name:OMELKINA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 64TH ST
Mailing Address - Street 2:UNIT D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5372
Mailing Address - Country:US
Mailing Address - Phone:917-589-4742
Mailing Address - Fax:
Practice Address - Street 1:236 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6302
Practice Address - Country:US
Practice Address - Phone:718-769-2698
Practice Address - Fax:718-769-2317
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004658224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant