Provider Demographics
NPI:1649586835
Name:KHAZANOVA, TATYANA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TATYANA
Middle Name:
Last Name:KHAZANOVA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:TATYANA
Other - Middle Name:
Other - Last Name:NATHANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2145 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5059
Mailing Address - Country:US
Mailing Address - Phone:718-757-1153
Mailing Address - Fax:
Practice Address - Street 1:2145 E 27TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5059
Practice Address - Country:US
Practice Address - Phone:718-757-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015672225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist