Provider Demographics
NPI:1669626651
Name:TYSON, PAIGE KATHERINE (MS OTR/L)
Entity Type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:KATHERINE
Last Name:TYSON
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9977 SHORE RD
Mailing Address - Street 2:APT 11 D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8253
Mailing Address - Country:US
Mailing Address - Phone:718-680-5610
Mailing Address - Fax:
Practice Address - Street 1:9977 SHORE RD
Practice Address - Street 2:APT 11 D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8253
Practice Address - Country:US
Practice Address - Phone:718-680-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010332225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist