Healthcare Provider Details

I. General information

NPI: 1336458603
Provider Name (Legal Business Name): PATRICIA MARIEEILEEN MAHANCRESCIMANNO MS,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MONTEBELLO RD
SUFFERN NY
10901-3824
US

IV. Provider business mailing address

1 KRISTEN LEAH LN
SALISBURY MILLS NY
12577-5324
US

V. Phone/Fax

Practice location:
  • Phone: 845-357-4466
  • Fax:
Mailing address:
  • Phone: 845-215-6019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number012672
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: