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NPI Code Detail

MEDICARE: MICHAEL C MAYO OTR/L

MEDICARE: MICHAEL C MAYO OTR/L
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 Therapist024344NY

General Provider Information

NPI Number : 1487267092
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL C MAYO OTR/L
Provider Business Mailing Address
First Line : 6 FRANKLIN CT
Second Line :
City : STILLWATER
State : NY
Zip : 12170-1331
Country : US
Telephone Number : 518-813-6246
Fax Number :
Provider Business Practice Location Address
First Line : 70 MALTA AVE
Second Line :
City : BALLSTON SPA
State : NY
Zip : 12020-1529
Country : US
Telephone Number : 518-884-7250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2020
Last Update Date : 08/25/2020

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Directions to “ MICHAEL C MAYO OTR/L” Practice Location

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