Healthcare Provider Details

I. General information

NPI: 1730389727
Provider Name (Legal Business Name): KRISTINA BOUTCHATSKI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 72ND ST 1A
BROOKLIN NY
11209
US

IV. Provider business mailing address

264 72ND ST APT 1A
BROOKLYN NY
11209-2151
US

V. Phone/Fax

Practice location:
  • Phone: 646-209-7043
  • Fax:
Mailing address:
  • Phone: 646-209-7043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number014370
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: