Provider Demographics
NPI:1225334204
Name:COVETT, MARLENE (OT)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:COVETT
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 1:46 EAST HOME RD
Mailing Address - Street 2:
Mailing Address - City:BOWMANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14026
Mailing Address - Country:US
Mailing Address - Phone:716-913-0503
Mailing Address - Fax:
Practice Address - Street 1:46 E HOME RD
Practice Address - Street 2:
Practice Address - City:BOWMANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14026-1004
Practice Address - Country:US
Practice Address - Phone:716-913-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004565-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004565-1OtherOCCUPATIONAL THERAPY LICENSE