Individual
MAYBELLINE TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 LIVINGSTON AVE, APT. 2J, MAMARONECK, NY 10543-3500
(917) 453-2508
Mailing address
300 LIVINGSTON AVE, APT. 2J, MAMARONECK, NY 10543-3500
(917) 453-2508
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
009479-1
NY
Other
Enumeration date
10/31/2008
Last updated
10/31/2008
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