Provider Demographics
NPI:1730410788
Name:YU, AENID MARIE MERCADO (OTR/L)
Entity type:Individual
Prefix:MS
First Name:AENID MARIE
Middle Name:MERCADO
Last Name:YU
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:AENID MARIE
Other - Middle Name:ORTEGA
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:6700 192ND ST APT 2004
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3740
Mailing Address - Country:US
Mailing Address - Phone:917-794-5777
Mailing Address - Fax:
Practice Address - Street 1:6700 192ND ST APT 2004
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3740
Practice Address - Country:US
Practice Address - Phone:917-794-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10376225X00000X
NY015020225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist