Provider Demographics
NPI:1699911917
Name:MYKOLIW, IRENE NONE (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:IRENE
Middle Name:NONE
Last Name:MYKOLIW
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 EAST 7TH ST
Mailing Address - Street 2:APARTMENT 14
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10003-8482
Mailing Address - Country:US
Mailing Address - Phone:212-979-6456
Mailing Address - Fax:212-979-6456
Practice Address - Street 1:465 GRAND ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10002-4800
Practice Address - Country:US
Practice Address - Phone:212-420-1999
Practice Address - Fax:212-420-1910
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004862-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist