MEDICARE: MARY SQUILLACE 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
1	252Y00000X	Early Intervention Provider Agency	0076971	NY

General Provider Information

NPI Number	:	1700035862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY SQUILLACE OT

Provider Business Mailing Address
First Line	:	710 LINCOLN BLVD
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2316
Country	:	US
Telephone Number	:	516-889-6939
Fax Number	:	516-889-6939

Provider Business Practice Location Address
First Line	:	710 LINCOLN BLVD
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2316
Country	:	US
Telephone Number	:	516-889-6939
Fax Number	:	516-889-6939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2008
Last Update Date	:	09/13/2008

Similar Medicare Providers

1992531156 — DOWNTOWN LONG BEACH DENTISTRY, INC
Practice Location Address:

560 PINE AVE
LONG BEACH, CA
90802-2316

Practice Phone: 562-314-4169
Practice Fax:

1831857416 — SYEDA SAMENA ALI NP
Practice Location Address:

2316 BROADWAY , APT 1R
LONG ISLAND CITY, NY
11106-4154

Practice Phone: 732-585-3335
Practice Fax:

1154369940 — SHARON GERSON ARNP
Practice Location Address:

841 BAY POINT DR
MADEIRA BEACH, FL
33708-2316

Practice Phone: 727-391-8429
Practice Fax:

1235412628 — ROBERT DONALD BRONNER
Practice Location Address:

9411 VELARDO DR
HUNTINGTON BEACH, CA
92646-2316

Practice Phone: 949-864-9712
Practice Fax:

1811376668 — JAEYOUNG KIM L. AC
Practice Location Address:

2316 ARTESIA BLVD , SUITE E
REDONDO BEACH, CA
90278-3187

Practice Phone: 425-412-0468
Practice Fax:

1265935514 — PYENGSOO JEONG
Practice Location Address:

2316 ARTESIA BLVD STE E
REDONDO BEACH, CA
90278-3187

Practice Phone: 562-403-3322
Practice Fax:

Directions to “ MARY SQUILLACE OT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.