Provider Demographics
NPI:1205525441
Name:URBASIK, MYRNA CAPINDO (OTA)
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:CAPINDO
Last Name:URBASIK
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BIRCH LN APT 21A
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-4306
Mailing Address - Country:US
Mailing Address - Phone:315-746-1256
Mailing Address - Fax:
Practice Address - Street 1:29 BIRCH LN APT 21A
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-4306
Practice Address - Country:US
Practice Address - Phone:315-746-1256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007201-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant