Provider Demographics
NPI:1104109834
Name:KELLY-MAGLIARO, MAURA RENEE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MAURA
Middle Name:RENEE
Last Name:KELLY-MAGLIARO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 ATLAS AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1123
Mailing Address - Country:US
Mailing Address - Phone:516-599-8637
Mailing Address - Fax:
Practice Address - Street 1:25 BUCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2219
Practice Address - Country:US
Practice Address - Phone:516-255-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006549174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist