MEDICARE: HEALTH PRO OT, PC

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	0155671	NY

General Provider Information

NPI Number	:	1659782720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH PRO OT, PC

Provider Business Mailing Address
First Line	:	2114 E 24TH ST # 3A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4902
Country	:	US
Telephone Number	:	718-942-4231
Fax Number	:	718-942-4232

Provider Business Practice Location Address
First Line	:	2114 E 24TH ST # 3A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4902
Country	:	US
Telephone Number	:	718-942-4231
Fax Number	:	718-942-4232

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LYUBOV SERVAKH
Credential	:	OTR/L
Telephone Number	:	718-942-4231

Provider Enumeration Date	:	05/12/2014
Last Update Date	:	05/12/2014

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