Healthcare Provider Details

I. General information

NPI: 1346729746
Provider Name (Legal Business Name): SARA RENEE KUKAFKA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEMPSTEAD TPKE
WEST HEMPSTEAD NY
11552-1450
US

IV. Provider business mailing address

49 EILEEN AVE
PLAINVIEW NY
11803-5202
US

V. Phone/Fax

Practice location:
  • Phone: 516-505-2200
  • Fax:
Mailing address:
  • Phone: 516-830-1448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number022720
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: