National Provider Identifier
Mary Mai Iwanenko, MS, OTR/L, ATP, SI/C
Mary Mai Iwanenko, MS, OTR/L, ATP, SI/C is listed in the NPPES registry with a primary specialty of Specialist in Lackawanna, NY and a listed phone number of (716) 822-4781.
Profile Overview
- NPI
- 1811173990
- Provider Type
- Individual
- Primary Specialty
- Specialist
- Enumeration Date
- January 18, 2008
- Last Updated
- January 18, 2008
Practice Location
- 1025 Ridge RD
- Lackawanna, NY 14218-1755
Phone: (716) 822-4781
Mailing Address
- 219 S Shore Blvd
- Lackawanna, NY 14218-1753
Specialties
- Specialist (174400000X)
Full Record
- NPI
- 1811173990
- Entity Type
- Individual
- Last Name
- Iwanenko
- First Name
- Mary
- Middle Name
- Mai
- Name Prefix
- Mrs.
- Credential
- MS, OTR/L, ATP, SI/C
- Mailing Street Address
- 219 S Shore Blvd
- Mailing City
- Lackawanna
- Mailing State
- NY
- Mailing ZIP Code
- 14218-1753
- Mailing Country
- US
- Mailing Phone
- (716) 362-9121
- Mailing Fax
- (716) 362-8989
- Practice Street Address
- 1025 Ridge RD
- Practice City
- Lackawanna
- Practice State
- NY
- Practice ZIP Code
- 14218-1755
- Practice Country
- US
- Practice Phone
- (716) 822-4781
- Practice Fax
- (716) 362-8989
- Enumeration Date
- January 18, 2008
- Last Updated
- January 18, 2008
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Specialist (174400000X)