Provider Demographics
NPI:1376848937
Name:MORAN, MARY ELIZABETH (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:MARY ELIZABETH
Other - Middle Name:
Other - Last Name:PLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:70 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4139
Mailing Address - Country:US
Mailing Address - Phone:518-636-9755
Mailing Address - Fax:
Practice Address - Street 1:70 5TH ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4139
Practice Address - Country:US
Practice Address - Phone:518-636-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP78805225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics