Provider Demographics
NPI:1952694903
Name:WULWICK, EMILY (OT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WULWICK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 7TH AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-7247
Mailing Address - Country:US
Mailing Address - Phone:718-369-8000
Mailing Address - Fax:718-433-9506
Practice Address - Street 1:263 7TH AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-7247
Practice Address - Country:US
Practice Address - Phone:718-369-8000
Practice Address - Fax:718-433-9506
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016709-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400051022Medicare PIN