Tyra M Banks, MS, OTR/L
Individual provider Active NPI Contractor · Baldwin, NY
NPI 1770738841 · NPPES record last updated Jul 9, 2018
Key facts
- NPI
- 1770738841
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 011886-1 (NY)
- Practice address
- 3512 Milburn Ave
Baldwin, NY 11510 - Phone
- (516) 860-9677
- NPI assigned
- Nov 17, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46TR00478900 | NJ | MD | Contractor |
| 011886-1 | NY | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cornerstone Kids OT PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 46TR00478900 | NJ | |
| Contractor | 171W00000X | 011886-1 | NY | Yes |
Addresses
Primary practice location
3512 Milburn Ave
Baldwin, NY 11510
Mailing address
3512 Milburn Ave
Baldwin, NY 11510-5158
Phone (516) 860-9677
Other providers in Baldwin, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.