Provider Demographics
NPI:1023343316
Name:CLEOPHAT, MARIE C (OTR)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:C
Last Name:CLEOPHAT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 JANOS LN
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-4134
Mailing Address - Country:US
Mailing Address - Phone:516-410-3548
Mailing Address - Fax:516-705-8931
Practice Address - Street 1:672 JANOS LN
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-4134
Practice Address - Country:US
Practice Address - Phone:516-410-3548
Practice Address - Fax:516-705-8931
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008681-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist