Provider Demographics
NPI:1538401633
Name:WOOD, MAGGIE LEE-O'ROURKE
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:LEE-O'ROURKE
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:32 STEWART AVE
Mailing Address - City:BOLTON LANDING
Mailing Address - State:NY
Mailing Address - Zip Code:12814-4006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:392 NEW VERMONT ROAD
Practice Address - Street 2:
Practice Address - City:BOLTON LANDING
Practice Address - State:NY
Practice Address - Zip Code:12814
Practice Address - Country:US
Practice Address - Phone:518-321-4526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017949225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist