Mark Russell Bantug, COTA
Individual provider Active NPI Occupational Therapy Assistant · Stony Point, NY
NPI 1881544039 · NPPES record last updated Jan 29, 2026
Key facts
- NPI
- 1881544039
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 009562 (NY)
- Practice address
- 40 Walter Dr
Stony Point, NY 10980-1039 - Phone
- (914) 441-1417
- NPI assigned
- Jan 29, 2026
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 009562 | NY | Yes |
Addresses
Primary practice location
40 Walter Dr
Stony Point, NY 10980-1039
Mailing address
40 Walter Dr
Stony Point, NY 10980-1039
Other providers in Stony Point, NY
- Anna Marie Olooney LLC
- Marianne Klotz Ansel
- Thomas J Avella
- Safa Ayub
- Janet Marie Baker
- Barbara Ann Barry
- Juditha J. Barthelemy
- Cindy Maria Bautista-Thomas
- Irma A Bello
- Mohammad Jawaid Bhatty
All providers in Stony Point, NY · Occupational Therapy Assistant 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 Jan 29, 2026. 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.