Provider Demographics
NPI:1003572629
Name:SCHIFFHAUER, MARA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:SCHIFFHAUER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 ARCH ST APT 802
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-2670
Mailing Address - Country:US
Mailing Address - Phone:609-784-4744
Mailing Address - Fax:
Practice Address - Street 1:56 MAIN ST UNIT 1A
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08088-8896
Practice Address - Country:US
Practice Address - Phone:609-388-4782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty