Healthcare Provider Details

I. General information

NPI: 1265739965
Provider Name (Legal Business Name): MARLA HARTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3349 JUNCTION BLVD
JACKSON HEIGHTS NY
11372-2031
US

IV. Provider business mailing address

3349 JUNCTION BLVD
JACKSON HEIGHTS NY
11372-2031
US

V. Phone/Fax

Practice location:
  • Phone: 718-478-7970
  • Fax:
Mailing address:
  • Phone: 718-478-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number006613
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: