Marissa Ann Mundy, OTR/L
Individual provider Active NPI Occupational Therapist · Broad Channel, NY
NPI 1013464585 · NPPES record last updated Sep 1, 2016
Key facts
- NPI
- 1013464585
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 020869 (NY)
- Practice address
- 55 West 15TH Road
Broad Channel, NY 11693 - Phone
- (917) 972-8157
- NPI assigned
- Sep 1, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020869 | NY | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 020869 | NY | Yes |
Addresses
Primary practice location
55 West 15TH Road
Broad Channel, NY 11693
Mailing address
55 West 15TH Road
Broad Channel, NY 11693
Phone (917) 972-8157
Other providers in Broad Channel, NY
- Gregory Charles Henkel
- Marianthi Koullias
- Kerry Ann Larkin
- Ann M Mills
- Allison Ann Moynihan
- Marcy Nussbaum
- Susan Oconnor
- Julia Rocco
- Linda Scott
- Jeanette Michelle Stewart
All providers in Broad Channel, NY · Occupational Therapist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.