Provider Demographics
NPI:1740743657
Name:BECKER, TANYA M (COTA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:M
Last Name:BECKER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:M
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA, BA
Mailing Address - Street 1:1201 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 34TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2416
Practice Address - Country:US
Practice Address - Phone:619-906-9324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant