MEDICARE: MAPLE GROVE OCCUPATIONAL THERAPY PLLC

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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1700720596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE GROVE OCCUPATIONAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	39 HAY MARKET RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-4939
Country	:	US
Telephone Number	:	585-623-3538
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 HAY MARKET RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-4939
Country	:	US
Telephone Number	:	585-623-3538
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST/OWNER
Name	:	JUSTINA DIANN MENDES
Credential	:	MS OTR/L
Telephone Number	:	585-623-3538

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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