Provider Demographics
NPI:1477142701
Name:CABOTAJE, MARVIN (ATC)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:CABOTAJE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 LIRA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5317
Mailing Address - Country:US
Mailing Address - Phone:240-603-0725
Mailing Address - Fax:
Practice Address - Street 1:300 COLLEGE PARK ATHLETICS PRACTICE FACILITY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45469-0001
Practice Address - Country:US
Practice Address - Phone:240-603-0725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0062912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer