Provider Demographics
NPI:1902183536
Name:BAUTISTA, MIRIAM (MA OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:MA OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-6804
Mailing Address - Country:US
Mailing Address - Phone:845-838-9232
Mailing Address - Fax:
Practice Address - Street 1:167 MYERS CORNERS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-3869
Practice Address - Country:US
Practice Address - Phone:845-298-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006674225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist