Individual
DIANA YAKUTILOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2075 E 68TH ST, BROOKLYN, NY 11234-6009
(718) 968-7866
Mailing address
6135 98TH ST, APT 3B, REGO PARK, NY 11374-1426
(718) 406-7820
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
P82982
NY
Other
Enumeration date
04/26/2012
Last updated
04/26/2012
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