Provider Demographics
NPI:1578872636
Name:EDWARDS, MARY ALICE (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALICE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:249 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550
Mailing Address - Country:US
Mailing Address - Phone:845-561-0670
Mailing Address - Fax:845-561-9456
Practice Address - Street 1:379 MOUNT HOPE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-344-2292
Practice Address - Fax:845-342-2054
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004872-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist