Provider Demographics
NPI:1790926384
Name:MARTIN, MARY ANNE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANNE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COVERED BRIDGE RD
Mailing Address - Street 2:9 COVERED BRIDGE RD.
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2807
Mailing Address - Country:US
Mailing Address - Phone:845-987-7777
Mailing Address - Fax:
Practice Address - Street 1:9 COVERED BRIDGE RD
Practice Address - Street 2:9 COVERED BRIDGE RD.
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-2807
Practice Address - Country:US
Practice Address - Phone:845-987-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004723225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist