Provider Demographics
NPI:1720372139
Name:CREMO, MARY B (OTA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:CREMO
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 1:1042 TOMAHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-3300
Mailing Address - Country:US
Mailing Address - Phone:518-377-5012
Mailing Address - Fax:
Practice Address - Street 1:1042 TOMAHAWK TRL
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-3300
Practice Address - Country:US
Practice Address - Phone:518-377-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001734-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant