Healthcare Provider Details

I. General information

NPI: 1558038422
Provider Name (Legal Business Name): ELINA YAKOBOV OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6660 BOOTH ST
REGO PARK NY
11374-4634
US

IV. Provider business mailing address

6660 BOOTH ST
REGO PARK NY
11374-4634
US

V. Phone/Fax

Practice location:
  • Phone: 347-656-2317
  • Fax:
Mailing address:
  • Phone: 347-656-2317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number025712-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number025712-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number025712-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: