MEDICARE: DANA P RACKOVSKY OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	017276	NY

General Provider Information

NPI Number	:	1194091686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA P RACKOVSKY OTR/L

Provider Business Mailing Address
First Line	:	3530 KINGS COLLEGE PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-1507
Country	:	US
Telephone Number	:	347-945-1513
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 KINGS COLLEGE PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-1507
Country	:	US
Telephone Number	:	347-945-1513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2012
Last Update Date	:	08/15/2013

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Directions to “ DANA P RACKOVSKY OTR/L” Practice Location

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