Provider Demographics
NPI:1447740709
Name:PRICE, MARQUIE R (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARQUIE
Middle Name:R
Last Name:PRICE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7221 BRADLEY DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-5976
Mailing Address - Country:US
Mailing Address - Phone:815-823-7208
Mailing Address - Fax:
Practice Address - Street 1:7221 BRADLEY DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-5976
Practice Address - Country:US
Practice Address - Phone:815-823-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17-44611106S00000X
IL056013745225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician