Provider Demographics
NPI:1154477057
Name:SNOW, MARLENE S (OTR/L, MS, SCLV, CDE)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:S
Last Name:SNOW
Suffix:
Gender:F
Credentials:OTR/L, MS, SCLV, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18433 SIERRA LN
Mailing Address - Street 2:
Mailing Address - City:NEWALLA
Mailing Address - State:OK
Mailing Address - Zip Code:74857-8449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18433 SIERRA LN
Practice Address - Street 2:
Practice Address - City:NEWALLA
Practice Address - State:OK
Practice Address - Zip Code:74857-8449
Practice Address - Country:US
Practice Address - Phone:405-391-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21801092163WD0400X
OKOT802171W00000X
225X00000X
OK802225XE0001X, 225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow VisionGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractor
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
Provider Identifiers
StateIdentifier IDID TypeIssuer
21801092OtherNATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS
OK200051810BMedicaid