MEDICARE: MISS AVIVA KELMAN OTR/L

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	021672	NY

General Provider Information

NPI Number	:	1770095499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AVIVA KELMAN OTR/L

Provider Business Mailing Address
First Line	:	56 BENNETT AVE APT 6K
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-2136
Country	:	US
Telephone Number	:	443-805-4312
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 BENNETT AVE APT 6K
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-2136
Country	:	US
Telephone Number	:	443-805-4312
Fax Number	:

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

Provider Enumeration Date	:	11/03/2017
Last Update Date	:	11/03/2017

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