Provider Demographics
NPI:1346094661
Name:MARNEJON, THOMAS ALEXANDER (OTR/L)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALEXANDER
Last Name:MARNEJON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 53RD ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-3224
Mailing Address - Country:US
Mailing Address - Phone:330-727-9677
Mailing Address - Fax:
Practice Address - Street 1:3260 LAKE POINTE BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6896
Practice Address - Country:US
Practice Address - Phone:330-727-9677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25752225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist