Provider Demographics
NPI:1750659348
Name:FOSTER, YANIQUE S (MS OTR/L)
Entity type:Individual
Prefix:MS
First Name:YANIQUE
Middle Name:S
Last Name:FOSTER
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 1:600 BAYCHESTER AVE APT 11G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4451
Mailing Address - Country:US
Mailing Address - Phone:212-464-7016
Mailing Address - Fax:
Practice Address - Street 1:600 BAYCHESTER AVE APT 11G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4451
Practice Address - Country:US
Practice Address - Phone:212-464-7016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017024-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist