MEDICARE: NORTHBOUND OT PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	252Y00000X	Early Intervention Provider Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003448648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHBOUND OT PLLC

Provider Business Mailing Address
First Line	:	702 KATHLEEN PL APT 4C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5143
Country	:	US
Telephone Number	:	212-464-8365
Fax Number	:	347-587-1915

Provider Business Practice Location Address
First Line	:	702 KATHLEEN PL APT 4C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5143
Country	:	US
Telephone Number	:	212-464-8365
Fax Number	:	347-587-1915

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANATOLY PIKMAN
Credential	:	OTR/L
Telephone Number	:	212-464-8365

Provider Enumeration Date	:	02/11/2020
Last Update Date	:	08/08/2022

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