Provider Demographics
NPI:1467806661
Name:SPEAR, MARIAH (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:SPEAR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22502 SAMBAR LOOP
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5377
Mailing Address - Country:US
Mailing Address - Phone:907-726-4663
Mailing Address - Fax:844-605-1820
Practice Address - Street 1:114 MACLAUGHLIN ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1136
Practice Address - Country:US
Practice Address - Phone:315-359-3673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
NY98193174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist