Provider Demographics
NPI:1801200746
Name:MARTYNAVA, TATSIANA I
Entity Type:Individual
Prefix:
First Name:TATSIANA
Middle Name:
Last Name:MARTYNAVA
Suffix:I
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TATSIANA
Other - Middle Name:
Other - Last Name:MARTYNAVA
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16904 25TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-7310
Mailing Address - Country:US
Mailing Address - Phone:253-507-2651
Mailing Address - Fax:
Practice Address - Street 1:16904 25TH AVE E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-7310
Practice Address - Country:US
Practice Address - Phone:253-507-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant