Provider Demographics
NPI:1881938645
Name:BASSANELLO, MARY JOY (COTA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JOY
Last Name:BASSANELLO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9233 MAIN ST # 51
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-1920
Mailing Address - Country:US
Mailing Address - Phone:716-983-7649
Mailing Address - Fax:
Practice Address - Street 1:9233 MAIN ST # 51
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1920
Practice Address - Country:US
Practice Address - Phone:716-983-7649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004495-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY225X00000XOtherSOLE PROVIDER