MEDICARE: MRS. MALKI KENIG O.T.R.

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	225X00000X	Occupational Therapist	003824	NY

General Provider Information

NPI Number	:	1205136819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MALKI KENIG O.T.R.

Provider Business Mailing Address
First Line	:	170 WASHINGTON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5057
Country	:	US
Telephone Number	:	718-983-6792
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 WASHINGTON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5057
Country	:	US
Telephone Number	:	718-983-6792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2010
Last Update Date	:	10/28/2010

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