Provider Demographics
NPI:1821623539
Name:JOSEPH, TAKEEMA I (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:TAKEEMA
Middle Name:I
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 MCCLELLAN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-5627
Mailing Address - Country:US
Mailing Address - Phone:518-772-9590
Mailing Address - Fax:
Practice Address - Street 1:43 CLARIDGE AVE FL 2
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1556
Practice Address - Country:US
Practice Address - Phone:516-502-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009181224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant