Provider Demographics
NPI:1578230975
Name:CAUCHARD, MARY E (OTRL)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:CAUCHARD
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WURTS AVE # 2
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-2308
Mailing Address - Country:US
Mailing Address - Phone:845-649-6951
Mailing Address - Fax:
Practice Address - Street 1:15 CATHERWOOD RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1071
Practice Address - Country:US
Practice Address - Phone:607-227-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024164-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist