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NPI Code Detail

MEDICARE: MARLY JOHANNA WIJNEN OTR

MEDICARE: MARLY JOHANNA WIJNEN OTR
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 Therapist005094-1NY

General Provider Information

NPI Number : 1780838490
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARLY JOHANNA WIJNEN OTR
Provider Business Mailing Address
First Line : 2465 BATHGATE AVE
Second Line :
City : BRONX
State : NY
Zip : 10458-5928
Country : US
Telephone Number : 171-836-7591
Fax Number : 171-836-7669
Provider Business Practice Location Address
First Line : 2465 BATHGATE AVE
Second Line :
City : BRONX
State : NY
Zip : 10458-5928
Country : US
Telephone Number : 171-836-7591
Fax Number : 171-836-7669
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2008
Last Update Date : 11/07/2008

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