Provider Demographics
NPI:1528186806
Name:MARSHALL, MARY E (OT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5881 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2910
Mailing Address - Country:US
Mailing Address - Phone:970-313-2775
Mailing Address - Fax:970-350-2777
Practice Address - Street 1:5881 W 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2910
Practice Address - Country:US
Practice Address - Phone:970-313-2775
Practice Address - Fax:970-350-2777
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO239129225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51558271Medicaid
COP00944887OtherMEDICARE RAILROAD CARRIER PTAN
CO51558271Medicaid
COCOA102002Medicare PIN