Provider Demographics
NPI:1720150659
Name:MONBORNE, MARGARET SUSAN (OTR)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:SUSAN
Last Name:MONBORNE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 RIVERSIDE DR.
Mailing Address - Street 2:CREDENTIALING DEPT @ LBC
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4246
Mailing Address - Country:US
Mailing Address - Phone:607-584-5497
Mailing Address - Fax:607-798-6730
Practice Address - Street 1:174 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1049
Practice Address - Country:US
Practice Address - Phone:607-729-0044
Practice Address - Fax:607-729-9994
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006302225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02009236Medicaid
NY5041880001Medicare NSC
NY02009236Medicaid
NYRA1550Medicare ID - Type UnspecifiedMEDICARE ID NUMBER