Provider Demographics
NPI:1932295037
Name:MERVIUS, MARA (MSORT/L)
Entity Type:Individual
Prefix:MRS
First Name:MARA
Middle Name:
Last Name:MERVIUS
Suffix:
Gender:F
Credentials:MSORT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EAST 59TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6502
Mailing Address - Country:US
Mailing Address - Phone:917-474-1172
Mailing Address - Fax:
Practice Address - Street 1:111 EAST 59TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6502
Practice Address - Country:US
Practice Address - Phone:917-474-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013454-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist