Provider Demographics
NPI:1205068657
Name:CUNNINGHAM-PORTNER, MARY CATHERINE (MOT, OTR/L)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CATHERINE
Last Name:CUNNINGHAM-PORTNER
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Gender:F
Credentials:MOT, OTR/L
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Mailing Address - Street 1:2625 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3634
Mailing Address - Country:US
Mailing Address - Phone:954-385-4696
Mailing Address - Fax:954-385-8385
Practice Address - Street 1:2625 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 3
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3634
Practice Address - Country:US
Practice Address - Phone:954-385-4696
Practice Address - Fax:954-385-8385
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2009-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOT11830225XF0002X, 225XM0800X, 225XN1300X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation