Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Provider Rehab, OT PC

Organization Occupational Therapist · NPI 1205294691

Provider Rehab, OT PC is an Occupational Therapist in Staten Island, New York. Works from 2 locations. Licensed in New York.

Licensed in
NY
In the registry since
2016
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

288 Sand Ln Ste 1
Staten Island, NY 10305-4512
Phone: (347) 766-9077
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3030 Emmons Ave Apt 5t, Brooklyn, NY 11235-2228 — (347) 766-9077

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X · Licence 63018851 (NY)

Record details

NPI number1205294691
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Dmitry Shevchenko — President · (347) 766-9077
NPI enumeratedFebruary 1, 2016
Last updated in NPPESMarch 5, 2020
Certification dateMarch 5, 2020
Mailing address3030 Emmons Ave Apt 5t, Brooklyn, NY 11235-2228

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