Provider Demographics
NPI:1629350509
Name:MAGGI, GLORIA A (COTA)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:A
Last Name:MAGGI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-9701
Mailing Address - Country:US
Mailing Address - Phone:845-534-3066
Mailing Address - Fax:
Practice Address - Street 1:24 IDLEWILD AVE
Practice Address - Street 2:
Practice Address - City:CORNWALL ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12520-1134
Practice Address - Country:US
Practice Address - Phone:845-534-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004895-1251300000X, 224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant