Provider Demographics
NPI:1083240675
Name:OAKES, MARINA MARIAN (PTA)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:MARIAN
Last Name:OAKES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11235 OAK LEAF DR APT 804
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1386
Mailing Address - Country:US
Mailing Address - Phone:315-956-9397
Mailing Address - Fax:
Practice Address - Street 1:11235 OAK LEAF DR APT 804
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1386
Practice Address - Country:US
Practice Address - Phone:315-956-9397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011736225200000X
MDA5156225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant