Provider Demographics
NPI:1063075992
Name:CARROZZO, MARISA (COTA/L)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:CARROZZO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WHITE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1629
Mailing Address - Country:US
Mailing Address - Phone:860-733-5524
Mailing Address - Fax:
Practice Address - Street 1:40 WHITE OAKS RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1629
Practice Address - Country:US
Practice Address - Phone:860-733-5524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010094224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010094OtherNYS COTA LICENSE