Provider Demographics
NPI:1730389727
Name:BOUTCHATSKI, KRISTINA (OTR/L)
Entity type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:
Last Name:BOUTCHATSKI
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 1:264 72ND ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2151
Mailing Address - Country:US
Mailing Address - Phone:646-209-7043
Mailing Address - Fax:
Practice Address - Street 1:264 72ND ST
Practice Address - Street 2:1A
Practice Address - City:BROOKLIN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:646-209-7043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273Y00000X
NY014370283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No273Y00000XHospital UnitsRehabilitation Unit