Provider Demographics
NPI:1205849833
Name:DY, MARC JONATHAN (OT)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:JONATHAN
Last Name:DY
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 FIELDCREST CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-7082
Mailing Address - Country:US
Mailing Address - Phone:615-429-1631
Mailing Address - Fax:615-824-5971
Practice Address - Street 1:102 FIELDCREST CIR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-7082
Practice Address - Country:US
Practice Address - Phone:615-429-1631
Practice Address - Fax:615-824-5971
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2460225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP28056Medicare UPIN
TN3655585Medicare PIN