Provider Demographics
NPI:1396122586
Name:EVELKIN, MICHAELA (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:EVELKIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:EVELKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:22 N 6TH ST
Mailing Address - Street 2:7A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249
Mailing Address - Country:US
Mailing Address - Phone:917-731-4538
Mailing Address - Fax:
Practice Address - Street 1:101 NORTHFOLK ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002
Practice Address - Country:US
Practice Address - Phone:121-256-6855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019624225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics