Provider Demographics
NPI:1356726004
Name:TAMAKUWALA, MONA (OTR/L)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:TAMAKUWALA
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 1:183 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3524
Mailing Address - Country:US
Mailing Address - Phone:845-706-9725
Mailing Address - Fax:
Practice Address - Street 1:183 SMITH AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3524
Practice Address - Country:US
Practice Address - Phone:845-706-9725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63 019831225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist