Individual
MISS MARLENE Y, CANELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
7217 48TH AVE, 1ST FLOOR, WOODSIDE, NY 11377-6012
(718) 476-1959
Mailing address
7217 48TH AVE, 1ST FLOOR, WOODSIDE, NY 11377-6012
(718) 476-1959
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
008212-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
224Z00000X
TAXONOMY
NY
Enumeration date
12/19/2012
Last updated
12/19/2012
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