Provider Demographics
NPI:1811922537
Name:BOCCIA, CYNTHIA A (OT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:BOCCIA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WALNUT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2260
Mailing Address - Country:US
Mailing Address - Phone:845-457-5555
Mailing Address - Fax:
Practice Address - Street 1:20 WALNUT ST
Practice Address - Street 2:SUITE D
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2230
Practice Address - Country:US
Practice Address - Phone:845-457-5555
Practice Address - Fax:845-457-5556
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010669225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQT8781Medicare PIN