Provider Demographics
NPI:1750843959
Name:DEKHKANOVA, TAMARA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:
Last Name:DEKHKANOVA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:AVEZBAKIYEV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11814 83RD AVE APT 4L
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1365
Mailing Address - Country:US
Mailing Address - Phone:917-353-3023
Mailing Address - Fax:
Practice Address - Street 1:7252 METROPOLITAN AVE STE 1
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2103
Practice Address - Country:US
Practice Address - Phone:718-326-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017290-1225XG0600X, 225XP0019X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation