Provider Demographics
NPI:1497937171
Name:BERUBE, MARCIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:
Last Name:BERUBE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 FIVAY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7180
Mailing Address - Country:US
Mailing Address - Phone:727-869-9479
Mailing Address - Fax:727-869-7135
Practice Address - Street 1:14100 FIVAY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7180
Practice Address - Country:US
Practice Address - Phone:727-869-9479
Practice Address - Fax:727-869-7135
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9987225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist