Provider Demographics
NPI:1427040872
Name:MARIN, NANCY ANN (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ANN
Last Name:MARIN
Suffix:
Gender:F
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 1:100 BOUGANVILLA DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3676
Mailing Address - Country:US
Mailing Address - Phone:904-280-5336
Mailing Address - Fax:904-373-0469
Practice Address - Street 1:5270 PALM VALLEY RD
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3200
Practice Address - Country:US
Practice Address - Phone:904-382-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1278225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL880751500Medicaid
FL880751500Medicaid