Basic Information
| Provider Information | |||||||||
| NPI: | 1508002502 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRATT | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | JOYCE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A., OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 STRATFORD AVE | ||||||||
| Address2: | |||||||||
| City: | GREENLAWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117402519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314868017 | ||||||||
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| Practice Location | |||||||||
| Address1: | 47 HUMPHREY DR | ||||||||
| Address2: | |||||||||
| City: | SYOSSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117914022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169217171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2008 | ||||||||
| LastUpdateDate: | 12/21/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 003367-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.