Provider Demographics
NPI:1205112869
Name:DEVADAS, MARY S (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:S
Last Name:DEVADAS
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 1:8904 204TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2208
Mailing Address - Country:US
Mailing Address - Phone:917-515-0228
Mailing Address - Fax:
Practice Address - Street 1:7712 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3402
Practice Address - Country:US
Practice Address - Phone:718-238-0311
Practice Address - Fax:718-238-0330
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017018-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist