MEDICARE: OT REHABILITATION SERVICES PLLC

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	46TR00702800	NJ
2	225X00000X	Occupational Therapist	019703	NY
3	225X00000X	Occupational Therapist	019788-1	NY

General Provider Information

NPI Number	:	1982062113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OT REHABILITATION SERVICES PLLC

Provider Business Mailing Address
First Line	:	2411 E 2ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6041
Country	:	US
Telephone Number	:	718-395-3155
Fax Number	:	718-395-3141

Provider Business Practice Location Address
First Line	:	2411 E 2ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6041
Country	:	US
Telephone Number	:	718-395-3155
Fax Number	:	718-395-3141

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	KRISTINA KIMACHENKO
Credential	:
Telephone Number	:	718-395-3155

Provider Enumeration Date	:	02/02/2016
Last Update Date	:	02/02/2017

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