Provider Demographics
NPI:1194222661
Name:TAMIR, SORAH (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SORAH
Middle Name:
Last Name:TAMIR
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:SORAH
Other - Middle Name:
Other - Last Name:WIELGUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA-L
Mailing Address - Street 1:1315 CAFFREY AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5112
Mailing Address - Country:US
Mailing Address - Phone:917-670-6157
Mailing Address - Fax:917-670-6157
Practice Address - Street 1:1315 CAFFREY AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5112
Practice Address - Country:US
Practice Address - Phone:917-670-6157
Practice Address - Fax:917-670-6157
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009670224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant