Provider Demographics
NPI:1205813649
Name:WALRATH, MARION D (OT)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:D
Last Name:WALRATH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3509
Mailing Address - Country:US
Mailing Address - Phone:207-283-1954
Mailing Address - Fax:
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:SUITE 1105
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3509
Practice Address - Country:US
Practice Address - Phone:207-283-1954
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT229225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1577Medicare ID - Type Unspecified