Provider Demographics
NPI:1275617805
Name:BIRCHANSKY, MARIE LYNNE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:LYNNE
Last Name:BIRCHANSKY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22404 SWORDFISH DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4610
Mailing Address - Country:US
Mailing Address - Phone:561-302-6728
Mailing Address - Fax:
Practice Address - Street 1:22404 SWORDFISH DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4610
Practice Address - Country:US
Practice Address - Phone:561-302-6728
Practice Address - Fax:561-477-9947
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT2135225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT 884183700Medicaid