Provider Demographics
NPI:1235493446
Name:VENZON, MARY MAY A (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MARY MAY
Middle Name:A
Last Name:VENZON
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 1:5304 80TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4732
Mailing Address - Country:US
Mailing Address - Phone:917-214-1428
Mailing Address - Fax:
Practice Address - Street 1:11919 GRAHAM CT
Practice Address - Street 2:COLLEGE POINT
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1047
Practice Address - Country:US
Practice Address - Phone:718-886-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013860225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist