Healthcare Provider Details

I. General information

NPI: 1740089424
Provider Name (Legal Business Name): OKSANA FAKHLAYEVA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6145 98TH ST APT 7E
REGO PARK NY
11374-1428
US

IV. Provider business mailing address

6145 98TH ST APT 7E
REGO PARK NY
11374-1428
US

V. Phone/Fax

Practice location:
  • Phone: 917-865-4489
  • Fax:
Mailing address:
  • Phone: 917-865-4489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number029944
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: