Provider Demographics
NPI:1841562204
Name:OCCUPATIONAL THERAPY SHINES, PC
Entity Type:Organization
Organization Name:OCCUPATIONAL THERAPY SHINES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHLEVNER
Authorized Official - Suffix:
Authorized Official - Credentials:OT, MS
Authorized Official - Phone:917-710-8871
Mailing Address - Street 1:2728 COYLE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1306
Mailing Address - Country:US
Mailing Address - Phone:917-710-8871
Mailing Address - Fax:
Practice Address - Street 1:2728 COYLE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1306
Practice Address - Country:US
Practice Address - Phone:917-710-8871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty