Provider Demographics
NPI:1609422591
Name:DEFORGE, MARGUERITE JEAN CONNERS (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:JEAN CONNERS
Last Name:DEFORGE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 LOW RD
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-4002
Mailing Address - Country:US
Mailing Address - Phone:315-573-2102
Mailing Address - Fax:
Practice Address - Street 1:196 LOW RD
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-4002
Practice Address - Country:US
Practice Address - Phone:315-573-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13267225X00000X
MA13239225X00000X
NY029174225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist