Provider Demographics
NPI:1558677260
Name:SOROKO, TANYA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:
Last Name:SOROKO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BETHLEHEM CT
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1306
Mailing Address - Country:US
Mailing Address - Phone:518-438-3287
Mailing Address - Fax:
Practice Address - Street 1:33 WILLOUGHBY DR
Practice Address - Street 2:
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205-2016
Practice Address - Country:US
Practice Address - Phone:518-608-5108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2014-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010149-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics