Individual
MRS. TAMARA DEKHKANOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
7252 METROPOLITAN AVE STE 1, MIDDLE VILLAGE, NY 11379-2103
(718) 326-0055
Mailing address
11814 83RD AVE APT 4L, KEW GARDENS, NY 11415-1365
(917) 353-3023
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
017290-1
NY
225XP0019X
Physical Rehabilitation Occupational Therapist
017290-1
NY
225XP0200X
Pediatric Occupational Therapist
Primary
017290-1
NY
Other
Enumeration date
04/05/2019
Last updated
04/05/2019
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