Individual
MARK RUSSELL BANTUG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
40 WALTER DR, STONY POINT, NY 10980-1039
(914) 441-1417
Mailing address
40 WALTER DR, STONY POINT, NY 10980-1039
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
009562
NY
Other
Enumeration date
01/29/2026
Last updated
01/29/2026
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