Healthcare Provider Details

I. General information

NPI: 1194263806
Provider Name (Legal Business Name): MARIEL VAKNIN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 FOREST HILL RD
STATEN ISLAND NY
10314-6336
US

IV. Provider business mailing address

1550 FOREST HILL RD
STATEN ISLAND NY
10314-6336
US

V. Phone/Fax

Practice location:
  • Phone: 347-461-1860
  • Fax:
Mailing address:
  • Phone: 347-461-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number021210-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: