Provider Demographics
NPI:1306121140
Name:FLEMING, TINA MS (COTA)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:MS
Last Name:FLEMING
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:41 ARCHIBALD ST.
Mailing Address - City:SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:12865-0299
Mailing Address - Country:US
Mailing Address - Phone:518-854-9134
Mailing Address - Fax:518-854-9134
Practice Address - Street 1:2 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:SCHAGHTICOKE
Practice Address - State:NY
Practice Address - Zip Code:12154-3908
Practice Address - Country:US
Practice Address - Phone:518-753-4458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005861-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant