Provider Demographics
NPI:1104064112
Name:SHAFFEE, MARION T (OTA/L)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:T
Last Name:SHAFFEE
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16215 HIGHLAND AVE
Mailing Address - Street 2:6S
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3452
Mailing Address - Country:US
Mailing Address - Phone:917-991-2632
Mailing Address - Fax:
Practice Address - Street 1:15645 84TH ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2617
Practice Address - Country:US
Practice Address - Phone:718-848-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007212-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant