Provider Demographics
NPI:1629208806
Name:HUERTER, MARIE ANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ANN
Last Name:HUERTER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ANN
Other - Last Name:FULGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:435 W 45TH ST APT GB
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-9094
Mailing Address - Country:US
Mailing Address - Phone:818-915-0789
Mailing Address - Fax:
Practice Address - Street 1:307 W 71ST ST APT 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3568
Practice Address - Country:US
Practice Address - Phone:818-915-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012719-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics