Provider Demographics
NPI:1700648409
Name:CONNELLY, MARGARITA ELENA (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:MARGARITA
Middle Name:ELENA
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6603 SWEETFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3196
Mailing Address - Country:US
Mailing Address - Phone:516-782-4453
Mailing Address - Fax:
Practice Address - Street 1:6603 SWEETFIELD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3196
Practice Address - Country:US
Practice Address - Phone:516-782-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14874224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant