Provider Demographics
NPI:1568973667
Name:MARIA C. CONNOLLY, OCCUPATIONAL THERAPY, PLLC
Entity Type:Organization
Organization Name:MARIA C. CONNOLLY, OCCUPATIONAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIULLI CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MA/OTR
Authorized Official - Phone:631-786-4767
Mailing Address - Street 1:9 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1856
Mailing Address - Country:US
Mailing Address - Phone:631-786-4767
Mailing Address - Fax:
Practice Address - Street 1:140 E MAIN ST STE 11A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2864
Practice Address - Country:US
Practice Address - Phone:631-786-4767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty