MEDICARE: MRS. RIKKI KOPOLOVICH OT

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	015163	NY

General Provider Information

NPI Number	:	1275861494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RIKKI KOPOLOVICH OT

Provider Business Mailing Address
First Line	:	856 46TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1656
Country	:	US
Telephone Number	:	718-435-7000
Fax Number	:	718-435-7066

Provider Business Practice Location Address
First Line	:	856 46TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1656
Country	:	US
Telephone Number	:	718-435-7000
Fax Number	:	718-435-7066

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

Provider Enumeration Date	:	11/29/2009
Last Update Date	:	11/29/2009

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