Provider Demographics
NPI:1508524331
Name:GIGLIOTTI-TUPAJ, MARY KATHRYN (ATR-BC,LCAT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHRYN
Last Name:GIGLIOTTI-TUPAJ
Suffix:
Gender:F
Credentials:ATR-BC,LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8257 SENECA TPKE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1119
Mailing Address - Country:US
Mailing Address - Phone:315-796-1065
Mailing Address - Fax:
Practice Address - Street 1:8257 SENECA TPKE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1119
Practice Address - Country:US
Practice Address - Phone:315-796-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001878-02221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist