Provider Demographics
NPI:1093024382
Name:VIVLAMORE, MARGO M (COTA)
Entity Type:Individual
Prefix:MS
First Name:MARGO
Middle Name:M
Last Name:VIVLAMORE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ISLAND ST PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NY
Mailing Address - Zip Code:13667
Mailing Address - Country:US
Mailing Address - Phone:518-483-7806
Mailing Address - Fax:
Practice Address - Street 1:99 ELM ST
Practice Address - Street 2:ST JOSEPHS ELEMENTARY
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1519
Practice Address - Country:US
Practice Address - Phone:518-483-7806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY64005130224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY64005130OtherNYS