Provider Demographics
NPI:1235829110
Name:FITZPATRICK, PATRICIA ANN (OT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:ANN
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 2456
Mailing Address - Street 2:
Mailing Address - City:AQUEBOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11931-2456
Mailing Address - Country:US
Mailing Address - Phone:631-974-2314
Mailing Address - Fax:
Practice Address - Street 1:5958 NY-25A
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792
Practice Address - Country:US
Practice Address - Phone:631-929-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007991-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist