Provider Demographics
NPI:1679912653
Name:TALEVSKA, GORDANA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:GORDANA
Middle Name:
Last Name:TALEVSKA
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 1:2523 31ST AVE APT A12
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3639
Mailing Address - Country:US
Mailing Address - Phone:646-407-9556
Mailing Address - Fax:
Practice Address - Street 1:2523 31ST AVE APT A12
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-3639
Practice Address - Country:US
Practice Address - Phone:646-407-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-23
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018040225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist