Provider Demographics
NPI:1730486069
Name:GEDNOV, TANIA ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:ANN
Last Name:GEDNOV
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:ANN
Other - Last Name:KRYWCUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:11912 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4106
Mailing Address - Country:US
Mailing Address - Phone:562-493-3545
Mailing Address - Fax:
Practice Address - Street 1:5901 E 7TH ST
Practice Address - Street 2:BLDG. 150, OT DEPT, BASEMENT
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822-5201
Practice Address - Country:US
Practice Address - Phone:562-493-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT0129174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT0129OtherSTATE OF CALIFORNIA PROFESSIONAL OCCUPATIONAL THERAPY LICENSE