Provider Demographics
NPI:1730332172
Name:PAIGE KATHERINE TYSON MS OTR/L, PC
Entity type:Organization
Organization Name:PAIGE KATHERINE TYSON MS OTR/L, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR/L
Authorized Official - Phone:718-680-5610
Mailing Address - Street 1:9977 SHORE RD
Mailing Address - Street 2:APT 11D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8253
Mailing Address - Country:US
Mailing Address - Phone:718-680-5610
Mailing Address - Fax:
Practice Address - Street 1:9977 SHORE RD
Practice Address - Street 2:APT 11D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8253
Practice Address - Country:US
Practice Address - Phone:718-680-5610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010332251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health