Provider Demographics
NPI:1295041432
Name:FITZGERALD, MARY BETH (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MARY BETH
Middle Name:
Last Name:FITZGERALD
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 1:43 PEACOCK LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4925
Mailing Address - Country:US
Mailing Address - Phone:631-543-8229
Mailing Address - Fax:
Practice Address - Street 1:1 EXPRESSWAY PLZ
Practice Address - Street 2:SUITE 106
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2047
Practice Address - Country:US
Practice Address - Phone:516-621-2681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011324-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist