Provider Demographics
NPI:1932517729
Name:ONISHCHENKO, YELENA (COTA)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:ONISHCHENKO
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 1:2453 64TH ST APT 16B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3411
Mailing Address - Country:US
Mailing Address - Phone:347-806-0605
Mailing Address - Fax:
Practice Address - Street 1:2453 64TH ST APT 16B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3411
Practice Address - Country:US
Practice Address - Phone:347-806-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008500-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant