Provider Demographics
NPI:1669911970
Name:GATTA, TAMI MICHELLE (MA, RDT, LCAT)
Entity type:Individual
Prefix:MS
First Name:TAMI
Middle Name:MICHELLE
Last Name:GATTA
Suffix:
Gender:F
Credentials:MA, RDT, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 WYCKOFF AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5757
Mailing Address - Country:US
Mailing Address - Phone:646-685-4322
Mailing Address - Fax:
Practice Address - Street 1:1080 WYCKOFF AVE
Practice Address - Street 2:D-04
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5757
Practice Address - Country:US
Practice Address - Phone:646-685-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1649221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist