Individual
KSENIYA SHIMUNOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
10240 62ND AVE APT 3E, FOREST HILLS, NY 11375-1031
(718) 592-7234
Mailing address
9110 146TH ST, JAMAICA, NY 11435-4301
(718) 464-2017
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
017227-1
NY
Other
Enumeration date
06/14/2012
Last updated
06/14/2012
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