Provider Demographics
NPI:1306005673
Name:TRANQUADA, VICKY M (OT)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:M
Last Name:TRANQUADA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:MICHAUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:66 MOORES HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553
Mailing Address - Country:US
Mailing Address - Phone:917-523-1073
Mailing Address - Fax:
Practice Address - Street 1:66 MOORES HILL ROAD
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553
Practice Address - Country:US
Practice Address - Phone:917-523-1073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010073225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYOTH000Medicare UPIN
NYA400010305Medicare PIN