MEDICARE: MRS. IRYNA VOLSKA OTR

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	171W00000X	Contractor	017659	NY
2	225X00000X	Occupational Therapist	46TR00604900	NJ
3	225X00000X	Occupational Therapist	017659	NY

General Provider Information

NPI Number	:	1780920892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IRYNA VOLSKA OTR

Provider Business Mailing Address
First Line	:	2150 CENTER AVE
Second Line	:	APT 4E
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5802
Country	:	US
Telephone Number	:	347-886-7410
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 CENTER AVE APT 4E
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-5802
Country	:	US
Telephone Number	:	347-886-7410
Fax Number	:

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

Provider Enumeration Date	:	12/17/2012
Last Update Date	:	05/03/2022

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