Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | 017290-1 | NY |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 017290-1 | NY |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 017290-1 | NY |
NPI | 1750843959 |
---|---|
Provider Name | Mrs. Tamara Dekhkanova |
First Address | Kew Gardens, NY 11415-1365 |
Second Address | Middle Village, NY 11379-2103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2019 |
Last Update Date | 05/04/2019 |