Provider Demographics
NPI:1417406174
Name:MARINOS, ANDREW JAMES (BS MOT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:MARINOS
Suffix:
Gender:M
Credentials:BS MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 S 48TH ST APT 210
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1776
Mailing Address - Country:US
Mailing Address - Phone:732-687-6031
Mailing Address - Fax:
Practice Address - Street 1:419 S 48TH ST APT 210
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1776
Practice Address - Country:US
Practice Address - Phone:732-687-6031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012705225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation