Provider Demographics
NPI:1093270308
Name:LEBREUX, MARINA BETH (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:BETH
Last Name:LEBREUX
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 GUINEA RD
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9725
Mailing Address - Country:US
Mailing Address - Phone:207-229-4049
Mailing Address - Fax:
Practice Address - Street 1:779 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-5218
Practice Address - Country:US
Practice Address - Phone:207-324-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3587225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist