Provider Demographics
NPI:1144793662
Name:CHOUINARD, MARLUCIA
Entity Type:Individual
Prefix:
First Name:MARLUCIA
Middle Name:
Last Name:CHOUINARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 N MCMULLEN BOOTH RD UNIT 1440
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-9995
Mailing Address - Country:US
Mailing Address - Phone:727-485-4660
Mailing Address - Fax:727-789-9204
Practice Address - Street 1:7316 PARKSIDE VILLAS DR N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1382
Practice Address - Country:US
Practice Address - Phone:727-485-4660
Practice Address - Fax:727-789-9204
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist