Provider Demographics
NPI:1861838633
Name:DRAKE, TANISHA D
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:D
Last Name:DRAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 W 31ST ST
Mailing Address - Street 2:APT 5
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-3434
Mailing Address - Country:US
Mailing Address - Phone:757-235-8614
Mailing Address - Fax:
Practice Address - Street 1:325 W 31ST ST
Practice Address - Street 2:APT 5
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-3434
Practice Address - Country:US
Practice Address - Phone:757-235-8614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant