Individual
KHANNA YAKUTILOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
14350 HOOVER AVE, APT 115, BRIARWOOD, NY 11435-2121
(347) 204-1416
Mailing address
14350 HOOVER AVE, APT 115, BRIARWOOD, NY 11435-2121
(347) 204-1416
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
008034-1
NY
Other
Enumeration date
11/03/2011
Last updated
11/03/2011
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