Basic Information
| Provider Information | |||||||||
| NPI: | 1720150659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONBORNE | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | SUSAN | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 169 RIVERSIDE DR. | ||||||||
| Address2: | CREDENTIALING DEPT @ LBC | ||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139054246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075845497 | ||||||||
| FaxNumber: | 6077986730 | ||||||||
| Practice Location | |||||||||
| Address1: | 174 OAKDALE RD | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 137901049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077290044 | ||||||||
| FaxNumber: | 6077299994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 03/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 006302 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 02009236 | 05 | NY | MEDICAID |