Provider Demographics
NPI:1457541831
Name:RYJNIKOVA, ELENA ANATOLJEVNA (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:ANATOLJEVNA
Last Name:RYJNIKOVA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 PENN ESTATES
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9028
Mailing Address - Country:US
Mailing Address - Phone:570-420-8699
Mailing Address - Fax:
Practice Address - Street 1:498 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-4432
Practice Address - Country:US
Practice Address - Phone:610-258-2985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009628225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist