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General NPI Number Information
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NPI Number | 1700486131
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Entity Type | Individual
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Provider Name | MARY JOYCE TAGATAC
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Gender | Female
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 13966 35TH AVE
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City | FLUSHING
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State | NY
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Zip | 11354-3524
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Country | US
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Telephone | 718-961-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 8950 56TH AVE APT 6P
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City | ELMHURST
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State | NY
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Zip | 11373-4906
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Country | US
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Telephone | 917-214-9980
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 009842
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License Number State | NY
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