Provider Demographics
NPI:1770463689
Name:BOBRIK, TATYANA (OT)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:BOBRIK
Suffix:
Gender:X
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HIGHLAND LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3346
Mailing Address - Country:US
Mailing Address - Phone:917-974-6966
Mailing Address - Fax:
Practice Address - Street 1:21 HIGHLAND LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3346
Practice Address - Country:US
Practice Address - Phone:917-974-6966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030289225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist