Basic Information
| Provider Information | |||||||||
| NPI: | 1669604500 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FITZGERALD | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 LOCUST ST | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | CORAOPOLIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151083954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122990704 | ||||||||
| FaxNumber: | 4122992823 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 LOCUST ST | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | CORAOPOLIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151083954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122990704 | ||||||||
| FaxNumber: | 4122992823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2009 | ||||||||
| LastUpdateDate: | 08/11/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OP002929L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.