Healthcare Provider Details

I. General information

NPI: 1730486069
Provider Name (Legal Business Name): TANIA ANN GEDNOV OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANIA ANN KRYWCUN OTR/L

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST BLDG. 150, OT DEPT, BASEMENT
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

11912 CHERRY ST
LOS ALAMITOS CA
90720-4106
US

V. Phone/Fax

Practice location:
  • Phone: 562-493-3545
  • Fax:
Mailing address:
  • Phone: 562-493-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT0129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: