Provider Demographics
NPI:1881073930
Name:PRODROMAKIS, TAYLOR ANN (COTA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANN
Last Name:PRODROMAKIS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:TAYLOR
Other - Middle Name:ANN
Other - Last Name:DONOHUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:60 SEAVIEW TER
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 SEAVIEW TER
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2928
Practice Address - Country:US
Practice Address - Phone:516-662-7035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008383-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant