Individual
MRS. TYRA M BANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
3512 MILBURN AVE, BALDWIN, NY 11510
(516) 860-9677
Mailing address
3512 MILBURN AVE, BALDWIN, NY 11510-5158
(516) 860-9677
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
011886-1
NY
171W00000X
Contractor
46TR00478900
NJ
Other
Enumeration date
11/17/2008
Last updated
07/09/2018
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