Provider Demographics
NPI:1578844023
Name:MAGNO, JANUARY (MS OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:JANUARY
Middle Name:
Last Name:MAGNO
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8634 89TH ST # 2RE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1326
Mailing Address - Country:US
Mailing Address - Phone:917-270-1055
Mailing Address - Fax:
Practice Address - Street 1:8634 89TH ST # 2RE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1326
Practice Address - Country:US
Practice Address - Phone:917-270-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0148251225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1053612945Medicaid