Provider Demographics
NPI:1225689615
Name:MARZAGAO, JORGE L (OTA)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:MARZAGAO
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-6056
Mailing Address - Country:US
Mailing Address - Phone:508-433-4400
Mailing Address - Fax:508-650-9209
Practice Address - Street 1:45 UNION ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-6056
Practice Address - Country:US
Practice Address - Phone:508-433-4400
Practice Address - Fax:508-650-9209
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAST235Z00000X224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant