Provider Demographics
NPI:1003357328
Name:MAURO, MICHELLE ROSE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROSE
Last Name:MAURO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E 14TH ST
Mailing Address - Street 2:APT 5G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3012
Mailing Address - Country:US
Mailing Address - Phone:201-390-9896
Mailing Address - Fax:
Practice Address - Street 1:535 E 14TH ST
Practice Address - Street 2:APT 5G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-3012
Practice Address - Country:US
Practice Address - Phone:201-390-9896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021331225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist