MEDICARE: MS. GAIL ANNE TISHCOFF MA, OTR

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	0050151	NY

General Provider Information

NPI Number	:	1760696090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAIL ANNE TISHCOFF MA, OTR

Provider Business Mailing Address
First Line	:	14461 ROOSEVELT AVE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-6252
Country	:	US
Telephone Number	:	718-269-2025
Fax Number	:

Provider Business Practice Location Address
First Line	:	3447 75 STREET
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1149
Country	:	US
Telephone Number	:	171-856-1255
Fax Number	:

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	10/14/2010

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