MEDICARE: LENA BOUCHKANETS O.T.

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	63020087	NY

General Provider Information

NPI Number	:	1710358312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LENA BOUCHKANETS O.T.

Provider Business Mailing Address
First Line	:	2 W END AVE
Second Line	:	2M
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4848
Country	:	US
Telephone Number	:	917-969-0214
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 W END AVE
Second Line	:	2M
City	:	BROOKLYN
State	:	NY
Zip	:	11235-4848
Country	:	US
Telephone Number	:	917-969-0214
Fax Number	:

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

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	10/08/2015

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