MEDICARE: YELENA ONISHCHENKO COTA

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	224Z00000X	Occupational Therapy Assistant	008500-1	NY

General Provider Information

NPI Number	:	1932517729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELENA ONISHCHENKO COTA

Provider Business Mailing Address
First Line	:	2453 64TH ST APT 16B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3411
Country	:	US
Telephone Number	:	347-806-0605
Fax Number	:

Provider Business Practice Location Address
First Line	:	2453 64TH ST APT 16B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3411
Country	:	US
Telephone Number	:	347-806-0605
Fax Number	:

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

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	07/24/2014

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