Provider Demographics
NPI:1124032305
Name:RUBRIGHT, MARILOU M (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARILOU
Middle Name:M
Last Name:RUBRIGHT
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 1:401 LOCUST STREET
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-3954
Mailing Address - Country:US
Mailing Address - Phone:412-299-0704
Mailing Address - Fax:412-299-2823
Practice Address - Street 1:401 LOCUST STREET
Practice Address - Street 2:SUITE 2A
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-3954
Practice Address - Country:US
Practice Address - Phone:412-299-0704
Practice Address - Fax:412-299-2823
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC-001826L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001467640OtherHIGHMARK PROVIDER NUMBER
PA1023014540001Medicaid
172678ND9Medicare UPIN