Provider Demographics
NPI:1790024966
Name:CHOMYSZAK, TANYA W (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:W
Last Name:CHOMYSZAK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18480 COCHRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-3379
Mailing Address - Country:US
Mailing Address - Phone:941-743-4700
Mailing Address - Fax:
Practice Address - Street 1:18480 COCHRAN BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-3379
Practice Address - Country:US
Practice Address - Phone:941-743-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 14483225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist