Provider Demographics
NPI:1972860567
Name:CITRON, MARJORY R (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MARJORY
Middle Name:R
Last Name:CITRON
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 1:206 W 106TH ST
Mailing Address - Street 2:#54
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3621
Mailing Address - Country:US
Mailing Address - Phone:917-608-5642
Mailing Address - Fax:
Practice Address - Street 1:175 W 166TH ST
Practice Address - Street 2:PS 126X
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-4500
Practice Address - Country:US
Practice Address - Phone:917-608-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016813225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist