MEDICARE: MISS JANINE MARIE TYSKA MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	015709-1	NY

General Provider Information

NPI Number	:	1568773349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JANINE MARIE TYSKA MS, OTR/L

Provider Business Mailing Address
First Line	:	1840 BOGART AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-3755
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 BOGART AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-3755
Country	:	US
Telephone Number	:	718-555-5555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	04/20/2012

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