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General NPI Number Information
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NPI Number | 1588557284
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Entity Type | Individual
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Provider Name | MIKAELA CABRAL-MARTIN
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Gender | Female
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Dates
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Enumeration Date | 05/31/2025
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Last Update Date | 05/31/2025
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Provider Practice Location Address
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Address Line | 4155 VETERANS HWY
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City | RONKONKOMA
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State | NY
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Zip | 11779-6063
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Country | US
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Telephone | 631-412-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 14 MILDRED PL
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City | LYNBROOK
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State | NY
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Zip | 11563-4218
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Country | US
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Telephone | 516-668-8275
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 033216
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License Number State | NY
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