1104062306 NPI number — MRS. MAUREEN O'KELLY GARRETT MAUREEN GARRETT

Table of content: MRS. MAUREEN O'KELLY GARRETT MAUREEN GARRETT (NPI 1104062306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104062306 NPI number — MRS. MAUREEN O'KELLY GARRETT MAUREEN GARRETT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARRETT
Provider First Name:
MAUREEN
Provider Middle Name:
O'KELLY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MAUREEN GARRETT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'KELLY
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A. CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104062306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 LINDEN PL
Provider Second Line Business Mailing Address:
APT 3
Provider Business Mailing Address City Name:
TARRYTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10591-3681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-366-8010
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NANUET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10954-3030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-627-9816
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  014422-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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