Provider Demographics
NPI:1477296945
Name:JAMES, MARCY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4329 N STATE ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:WOLF LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:62998-1123
Mailing Address - Country:US
Mailing Address - Phone:573-576-6344
Mailing Address - Fax:
Practice Address - Street 1:4329 N STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:WOLF LAKE
Practice Address - State:IL
Practice Address - Zip Code:62998-1123
Practice Address - Country:US
Practice Address - Phone:573-576-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001014098224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant