Provider Demographics
NPI:1144618950
Name:MORTERA, MARIANNE H (PHD, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:H
Last Name:MORTERA
Suffix:
Gender:F
Credentials:PHD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 2ND ST
Mailing Address - Street 2:APT. 1L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2563
Mailing Address - Country:US
Mailing Address - Phone:718-930-9276
Mailing Address - Fax:
Practice Address - Street 1:180 W END AVE
Practice Address - Street 2:SUITE 1M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4902
Practice Address - Country:US
Practice Address - Phone:212-600-4781
Practice Address - Fax:800-655-3780
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004374-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor