MEDICARE: MICHELLE KOSOVOY

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	021508	NY

General Provider Information

NPI Number	:	1770013864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE KOSOVOY

Provider Business Mailing Address
First Line	:	2509 E 64 STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2509 E 64TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6920
Country	:	US
Telephone Number	:	347-703-5388
Fax Number	:

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

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	06/13/2017

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Directions to “ MICHELLE KOSOVOY ” Practice Location

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