=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164677522
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FLORA TSANG MA, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2008
-----------------------------------------------------
Last Update Date | 05/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13616 35TH AVE STE 1B
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11354-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-968-0548
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25805 PEMBROKE AVE
-----------------------------------------------------
City | GREAT NECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11020-1039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-813-4770
-----------------------------------------------------
Fax | 516-482-1257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 005017
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------