Healthcare Provider Details

I. General information

NPI: 1164731410
Provider Name (Legal Business Name): MARY W. PERKINS MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 BALDWIN RD
RUSHVILLE NY
14544-9738
US

IV. Provider business mailing address

131 DRUMLIN CT
NEWARK NY
14513-1863
US

V. Phone/Fax

Practice location:
  • Phone: 585-554-6492
  • Fax:
Mailing address:
  • Phone: 315-332-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0116741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: