Provider Demographics
NPI:1811609381
Name:COYNE, MARISSA (COTA/L)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:COYNE
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 1:476 AWOSTING RD
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-5566
Mailing Address - Country:US
Mailing Address - Phone:845-551-2605
Mailing Address - Fax:
Practice Address - Street 1:726 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2654
Practice Address - Country:US
Practice Address - Phone:845-551-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011262-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant