Provider Demographics
NPI:1588879985
Name:JM OCCUPATIONAL THERAPY,PLLC
Entity type:Organization
Organization Name:JM OCCUPATIONAL THERAPY,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:MARAVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:OCCUPATIONAL THERAPY
Authorized Official - Phone:718-791-8423
Mailing Address - Street 1:8672 188TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1110
Mailing Address - Country:US
Mailing Address - Phone:718-791-8423
Mailing Address - Fax:718-454-0506
Practice Address - Street 1:8672 188TH ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1110
Practice Address - Country:US
Practice Address - Phone:718-791-8423
Practice Address - Fax:718-454-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005784305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service