Provider Demographics
NPI:1730499591
Name:MIYOSHI, MARI (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MARI
Middle Name:
Last Name:MIYOSHI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E 77TH ST
Mailing Address - Street 2:APT 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:421 E 77TH ST
Practice Address - Street 2:APT 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-2309
Practice Address - Country:US
Practice Address - Phone:301-523-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013451-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist