Provider Demographics
NPI:1639343205
Name:GOURAS-CARTY, DAWN RENEE (COTA)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:RENEE
Last Name:GOURAS-CARTY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 34TH AVE APT 326
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-3310
Mailing Address - Country:US
Mailing Address - Phone:917-692-0018
Mailing Address - Fax:
Practice Address - Street 1:8610 34TH AVE APT 326
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3310
Practice Address - Country:US
Practice Address - Phone:917-692-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004279-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant