Provider Demographics
NPI:1972670834
Name:ORT, MERRY (MS,OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:MERRY
Middle Name:
Last Name:ORT
Suffix:
Gender:F
Credentials:MS,OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3730
Mailing Address - Country:US
Mailing Address - Phone:917-733-8860
Mailing Address - Fax:
Practice Address - Street 1:2072 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7379
Practice Address - Country:US
Practice Address - Phone:178-616-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009639225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1699651OtherGHI
NYP3598949OtherOXFORD
NY1699651OtherGHI