Provider Demographics
NPI:1538273982
Name:KOTLIN, SVETLANA (PT)
Entity type:Individual
Prefix:MS
First Name:SVETLANA
Middle Name:
Last Name:KOTLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 THIMBLEBERRY RD
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4388
Mailing Address - Country:US
Mailing Address - Phone:518-783-0286
Mailing Address - Fax:
Practice Address - Street 1:288 THIMBLEBERRY RD
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-4388
Practice Address - Country:US
Practice Address - Phone:518-783-0286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0180481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC7015Medicare ID - Type Unspecified