Provider Demographics
NPI:1134547946
Name:MOONEY, CAROL ANN (COTA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:MOONEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:MOONEY HEVESI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:77-24 141 STREET
Mailing Address - Street 2:APT F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:718-591-3919
Mailing Address - Fax:
Practice Address - Street 1:84-60 PARSONS BOULEVARD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-298-6206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008363-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant