Provider Demographics
NPI:1386176931
Name:WENNMACHER, TANYA
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:WENNMACHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 13TH AVE APT 2DD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3567
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6105
Practice Address - Country:US
Practice Address - Phone:718-621-2730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2018-07-17
Deactivation Date:2017-07-07
Deactivation Code:
Reactivation Date:2018-02-13
Provider Licenses
StateLicense IDTaxonomies
CA17286225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist