Provider Demographics
NPI:1760132252
Name:HORACIUS, MARIE ELODIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELODIE
Last Name:HORACIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 ROCKAWAY PKWY APT 5E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3317
Mailing Address - Country:US
Mailing Address - Phone:347-351-6256
Mailing Address - Fax:
Practice Address - Street 1:277 ROCKAWAY PKWY APT 5E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3317
Practice Address - Country:US
Practice Address - Phone:347-351-6256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026199225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics