MEDICARE: TAWANA MARCIAL

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	011822-1	NY

General Provider Information

NPI Number	:	1831387398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAWANA MARCIAL

Provider Business Mailing Address
First Line	:	11949 223RD ST
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-2023
Country	:	US
Telephone Number	:	212-221-1544
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 E 45TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2112
Country	:	US
Telephone Number	:	212-221-1544
Fax Number	:

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

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	03/09/2022

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Directions to “ TAWANA MARCIAL ” Practice Location

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