Provider Demographics
NPI:1255315255
Name:HOOK, MARIE M (OTR)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:M
Last Name:HOOK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:M
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3270 LIBERTY RD S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:503-371-0779
Mailing Address - Fax:503-371-0886
Practice Address - Street 1:3270 LIBERTY RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-371-0779
Practice Address - Fax:503-371-0886
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR319194225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027926Medicaid
OR027926Medicaid
Q50461Medicare UPIN