Healthcare Provider Details

I. General information

NPI: 1770174096
Provider Name (Legal Business Name): MARCELLA GUILFOYLE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 EXECUTIVE DR STE 108
PLAINVIEW NY
11803-1707
US

IV. Provider business mailing address

7 OLIVE CT
ROCKVILLE CENTRE NY
11570-5918
US

V. Phone/Fax

Practice location:
  • Phone: 517-576-2040
  • Fax:
Mailing address:
  • Phone: 516-639-7153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number025334
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: