Provider Demographics
NPI:1962657247
Name:BAMFORD, MARY C (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:BAMFORD
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 1:1 POND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-2224
Mailing Address - Country:US
Mailing Address - Phone:603-964-6561
Mailing Address - Fax:
Practice Address - Street 1:1247 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NH
Practice Address - Zip Code:03870-2346
Practice Address - Country:US
Practice Address - Phone:603-964-6561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-30
Last Update Date:2008-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0157225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30006907Medicaid