Provider Demographics
NPI:1013750827
Name:APOLLO, MARY K (RDH, QOM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:APOLLO
Suffix:
Gender:F
Credentials:RDH, QOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 HARTWELL ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5312
Mailing Address - Country:US
Mailing Address - Phone:201-790-4616
Mailing Address - Fax:
Practice Address - Street 1:756 HARTWELL ST
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5312
Practice Address - Country:US
Practice Address - Phone:201-790-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22H100779600224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty