Individual
MS. CONNIE WAH TAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
227 MADISON ST, MEDICAL STAFF OFFICE, ROOM 1249, NEW YORK, NY 10002-7537
(212) 238-7614
(212) 238-7009
Mailing address
636 SAINT MARKS AVE, WESTFIELD, NJ 07090-1346
(908) 232-5290
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00766600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008593
NYS LICENSE#
NY
01
—
46TR00766600
NJ LICENSE #
NJ
Enumeration date
10/06/2006
Last updated
03/18/2019
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