Provider Demographics
NPI:1447528781
Name:GRYNHEIM, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:GRYNHEIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:WOLFSET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:972 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6609
Mailing Address - Country:US
Mailing Address - Phone:845-352-3307
Mailing Address - Fax:845-352-3375
Practice Address - Street 1:972 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-6609
Practice Address - Country:US
Practice Address - Phone:845-352-3307
Practice Address - Fax:845-352-3375
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007355225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist