Provider Demographics
NPI:1093554297
Name:TARAZONA SANCHEZ, KATHERINE (OT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:TARAZONA SANCHEZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3447 CRESCENT ST
Mailing Address - Street 2:AP 2T
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106
Mailing Address - Country:US
Mailing Address - Phone:516-660-1504
Mailing Address - Fax:
Practice Address - Street 1:3447 CRESCENT ST
Practice Address - Street 2:AP 2T
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106
Practice Address - Country:US
Practice Address - Phone:516-660-1504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028918225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist