| Doctor Name: | MARY OOT |
| NPI Number: | 1023048048 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | F330713 |
| Business Practice Address: | 5900 N Burdick St Suite 204 East Syracuse, NY - 130579462 |
| Business Phone Number: | 3156568999 |
| Business Fax Number: | 3156568877 |
| Mailing Address: | 104 Thorndike Ln, MINOA |
| State: | NY |
| Postal Code: | 131161128 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/04/2006 |
| NPI Last Update Date: | 02/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F330713 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |