Active NPI
Tatyana Prusakova
- Occupational Therapist
- Holbrook, NY
National Provider Identifier
1548625601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 013901
- Practice address
- 20 Peachtree CT
Suite 105
Holbrook, NY 11741-4616 - Phone
- (631) 467-3700
- Fax
- (631) 467-0928
- NPI assigned
- Dec 16, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 013901 | NY | Primary |
Addresses
Primary practice location
20 Peachtree CT
Suite 105
Holbrook, NY 11741-4616
Mailing address
830 James St
Syracuse, NY 13203-2541
Phone (315) 424-8400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450224000000",
"number": "1548625601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "830 JAMES ST",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132032541",
"telephone_number": "315-424-8400",
"fax_number": "315-424-8400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 PEACHTREE CT",
"address_2": "SUITE 105",
"city": "HOLBROOK",
"state": "NY",
"postal_code": "117414616",
"telephone_number": "631-467-3700",
"fax_number": "631-467-0928"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUSAKOVA",
"first_name": "TATYANA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-16",
"last_updated": "2015-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "013901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holbrook, NY
- Paul David Priolo, DC
- PRN Physical & Occupational Therapy Network
- PRN Physical Therapy PC
- PRN Physical, Occupational and Speech Therapy Network, PLLC
- Professional Occupational & Physical Therapy, PLLC
- Kimberly Ann Pulitano, SLP
- Christa Leamar Nograles Querubin, PT
- Laurance Anne Raio, MS PSYCHOLOGY
- Debbie Ramos-Rudiger, LMSW
- Charlene E Raygada, RN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.