Provider Demographics
NPI:1669748968
Name:KHODZHAYEVA, NELLYA (OTR/L)
Entity type:Individual
Prefix:MS
First Name:NELLYA
Middle Name:
Last Name:KHODZHAYEVA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2512
Mailing Address - Country:US
Mailing Address - Phone:718-864-3651
Mailing Address - Fax:347-406-7266
Practice Address - Street 1:5620 AVENUE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2512
Practice Address - Country:US
Practice Address - Phone:718-864-3651
Practice Address - Fax:347-406-7266
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012933-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist