Provider Demographics
NPI:1417680919
Name:VIERA, MARILYN (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:VIERA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13513 HAWTREE ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2827
Mailing Address - Country:US
Mailing Address - Phone:718-637-7807
Mailing Address - Fax:
Practice Address - Street 1:13513 HAWTREE ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2827
Practice Address - Country:US
Practice Address - Phone:718-637-7807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-03
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025180225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist