Healthcare Provider Details

I. General information

NPI: 1609951219
Provider Name (Legal Business Name): JAMES JOSEPH MRUK MS, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WYOMING COUNTY COMMUNITY HOSPITAL 400 NORTH MAIN ST.
WARSAW NY
14569
US

IV. Provider business mailing address

731 GABBEY RD
CORFU NY
14036-9712
US

V. Phone/Fax

Practice location:
  • Phone: 585-749-5735
  • Fax:
Mailing address:
  • Phone: 585-542-3986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number010105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: