Provider Demographics
NPI:1336379908
Name:TAM, ANGELA T (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:T
Last Name:TAM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:T
Other - Last Name:LEUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7305 220TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3037
Mailing Address - Country:US
Mailing Address - Phone:718-664-7390
Mailing Address - Fax:
Practice Address - Street 1:7305 220TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3037
Practice Address - Country:US
Practice Address - Phone:718-664-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010598-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist