Provider Demographics
NPI:1881849768
Name:PROCHILO, INKEN MARIA (COTA/L)
Entity Type:Individual
Prefix:
First Name:INKEN
Middle Name:MARIA
Last Name:PROCHILO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 OELSNER DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1228
Mailing Address - Country:US
Mailing Address - Phone:631-757-6149
Mailing Address - Fax:
Practice Address - Street 1:27 OELSNER DR
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1228
Practice Address - Country:US
Practice Address - Phone:631-757-6149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006661-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant