Individual
MARIAN ROSE WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
5225 NESCONSET HWY STE 30, PORT JEFF STA, NY 11776-2060
(631) 473-4284
Mailing address
5225 NESCONSET HWY, PORT JEFFERSON STATION, NY 11776-2053
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
008016
NY
Other
Enumeration date
12/03/2013
Last updated
12/03/2013
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