MEDICARE: ELENA N LEVTCHENKO 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	8473	CA

General Provider Information

NPI Number	:	1972135705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA N LEVTCHENKO OTR/L

Provider Business Mailing Address
First Line	:	18601 SHERMAN WAY STE B157
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-4100
Country	:	US
Telephone Number	:	818-419-4066
Fax Number	:	818-827-1702

Provider Business Practice Location Address
First Line	:	18425 BURBANK BLVD STE 520
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-6687
Country	:	US
Telephone Number	:	818-758-2673
Fax Number	:	818-264-7787

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

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	10/01/2022

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