Provider Demographics
NPI:1023390093
Name:PATELL, MARY ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:PATELL
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 1:14670 SAND PLACE RD
Mailing Address - Street 2:
Mailing Address - City:MANNSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13661-4263
Mailing Address - Country:US
Mailing Address - Phone:315-387-5200
Mailing Address - Fax:
Practice Address - Street 1:14670 SAND PLACE RD
Practice Address - Street 2:
Practice Address - City:MANNSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13661-4263
Practice Address - Country:US
Practice Address - Phone:315-387-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003656-1251300000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No251E00000XAgenciesHome Health