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General NPI Number Information
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NPI Number | 1881311454
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Entity Type | Individual
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Provider Name | FELISSA LULKIN OTA
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Gender | Female
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Dates
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Enumeration Date | 10/25/2022
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 25 CARRIER ST
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City | LIBERTY
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State | NY
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Zip | 12754-1903
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Country | US
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Telephone | 845-281-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 45 RUTH CT
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City | MIDDLETOWN
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State | NY
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Zip | 10940-5329
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Country | US
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Telephone | 845-649-8092
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | P118595
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License Number State | NY
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