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NPI Code Detail

MEDICARE: MARK EDWARD CONSTANTINO OT

MEDICARE: MARK EDWARD CONSTANTINO OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist010676-1NY

General Provider Information

NPI Number : 1144355017
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK EDWARD CONSTANTINO OT
Provider Business Mailing Address
First Line : 5 CHARLES ST
Second Line :
City : FREWSBURG
State : NY
Zip : 14738-9547
Country : US
Telephone Number : 716-569-2240
Fax Number :
Provider Business Practice Location Address
First Line : 150 PRATHER AVE
Second Line :
City : JAMESTOWN
State : NY
Zip : 14701-6710
Country : US
Telephone Number : 716-484-6659
Fax Number : 716-985-6657
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2007
Last Update Date : 07/08/2007

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