Individual provider Active NPI

Anthony Martin Marra III, OTR/L

  • Occupational Therapist
  • Wellsville, NY
National Provider Identifier
1558395459
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
12829-0 Issued in NY
Practice address
191 N Main St
Wellsville, NY 14895-1150
Phone
(158) 559-6401
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 12829-0 NY Primary

Addresses

Primary practice location

191 N Main St
Wellsville, NY 14895-1150

Mailing address

303 King St
Olean, NY 14760-3741
Phone (171) 637-3546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170419000922 NY Practitioner - Occupational Therapist in Private Practice 2567748916 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chemung-Schuyler Counties Chapter, Nysarc, IncGroup PAC ID 3577980622, 17 clinicians

Practice addresses (Care Compare)

240 Oconnor St
Wellsville, NY 14895-1055
Phone (607) 734-6151

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12829-0NYMDOccupational Therapist
012829NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Chemung-Schuyler Counties Chapter, Nysarc, Inc. CurrentSince Jul 1, 2020 Accepting new patients

Locations

711 Sullivan St
Elmira, NY 14901
Phone (607) 535-6934

103 S Porter St
Watkins Glen, NY 14891

240 Oconnor St
Wellsville, NY 14895
Phone (585) 593-3005

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1558395459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 KING ST",
            "city": "OLEAN",
            "state": "NY",
            "postal_code": "147603741",
            "telephone_number": "171-637-3546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 N MAIN ST",
            "city": "WELLSVILLE",
            "state": "NY",
            "postal_code": "148951150",
            "telephone_number": "158-559-6401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARRA III",
        "first_name": "ANTHONY",
        "middle_name": "MARTIN",
        "name_prefix": "Mr.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "12829-0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellsville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.