Active NPI
Mary Angelina Mirabella, MS, OTR/L
- Occupational Therapist
- Ithaca, NY
National Provider Identifier
1497110613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 019910-1
- Practice address
- 400 Lake St
Ithaca, NY 14850-2132 - Phone
- (607) 274-2102
- NPI assigned
- Dec 16, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 019910-1 | NY | Primary |
Addresses
Primary practice location
400 Lake St
Ithaca, NY 14850-2132
Mailing address
400 Lake St
Ithaca, NY 14850-2132
Phone (607) 274-2102
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019910-1 | Other | NY | OCCUPATIONAL THERAPY STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019910-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450224000000",
"number": "1497110613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 LAKE ST",
"city": "ITHACA",
"state": "NY",
"postal_code": "148502132",
"telephone_number": "607-274-2102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 LAKE ST",
"city": "ITHACA",
"state": "NY",
"postal_code": "148502132",
"telephone_number": "607-274-2102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRABELLA",
"first_name": "MARY",
"middle_name": "ANGELINA",
"credential": "MS, OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-16",
"last_updated": "2015-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "019910-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OCCUPATIONAL THERAPY STATE LICENSE",
"identifier": "019910-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ithaca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.