Provider Demographics
NPI:1457575441
Name:DUBITSKY, TAMI MELISSA (MS OTR L)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:MELISSA
Last Name:DUBITSKY
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BOONE STREET
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7408
Mailing Address - Country:US
Mailing Address - Phone:917-826-6203
Mailing Address - Fax:
Practice Address - Street 1:31 BOONE STREET
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7408
Practice Address - Country:US
Practice Address - Phone:917-826-6203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11833225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8918635 00Medicaid