Provider Demographics
NPI:1528205416
Name:THOMESEN, MAURA CATHERINE (MA,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MAURA
Middle Name:CATHERINE
Last Name:THOMESEN
Suffix:
Gender:F
Credentials:MA,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13532 HORACE HARDING EXPY
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1030
Mailing Address - Country:US
Mailing Address - Phone:718-961-4907
Mailing Address - Fax:
Practice Address - Street 1:13532 HORACE HARDING EXPY
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1030
Practice Address - Country:US
Practice Address - Phone:718-961-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003042-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist