Provider Demographics
NPI:1487176202
Name:KARTAK, TANAE (OTR/L)
Entity type:Individual
Prefix:
First Name:TANAE
Middle Name:
Last Name:KARTAK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TANAE
Other - Middle Name:
Other - Last Name:NOVOTNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GREGORY
Mailing Address - State:SD
Mailing Address - Zip Code:57533-1302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 PARK AVE
Practice Address - Street 2:
Practice Address - City:GREGORY
Practice Address - State:SD
Practice Address - Zip Code:57533-1302
Practice Address - Country:US
Practice Address - Phone:605-835-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1094225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist