Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 63019452 | NY |
NPI | 1003208133 |
---|---|
Provider Name | Tanya Feden |
First Address | Brooklyn, NY 11235-5840 |
Second Address | Brooklyn, NY 11235-5840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2015 |
Last Update Date | 26/02/2015 |