Healthcare Provider Details

I. General information

NPI: 1487807426
Provider Name (Legal Business Name): MARY-ANN HASKELL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 STONE LN
WEST HURLEY NY
12491-5019
US

IV. Provider business mailing address

PO BOX 330
LAKE KATRINE NY
12449-0330
US

V. Phone/Fax

Practice location:
  • Phone: 845-339-2215
  • Fax: 845-339-2215
Mailing address:
  • Phone: 845-339-2215
  • Fax: 845-339-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number007548-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: