Provider Demographics
NPI:1669698106
Name:BAGOSY, MARY KATHLEEN (OTR)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHLEEN
Last Name:BAGOSY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:KATHLEEN
Other - Last Name:MIRAGLIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2514 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21087-1007
Mailing Address - Country:US
Mailing Address - Phone:410-877-7447
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:610-834-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02535225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist