Provider Demographics
NPI:1982062113
Name:OT REHABILITATION SERVICES PLLC
Entity Type:Organization
Organization Name:OT REHABILITATION SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMACHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-395-3155
Mailing Address - Street 1:2411 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6041
Mailing Address - Country:US
Mailing Address - Phone:718-395-3155
Mailing Address - Fax:718-395-3141
Practice Address - Street 1:2411 E 2ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6041
Practice Address - Country:US
Practice Address - Phone:718-395-3155
Practice Address - Fax:718-395-3141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019788-1225X00000X
NJ46TR00702800225X00000X
NY019703225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty