Provider Demographics
NPI:1558428110
Name:PENDL, MARCIA JOAN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:JOAN
Last Name:PENDL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:MARCIA
Other - Middle Name:JOAN
Other - Last Name:HANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:10117 OAK BARK LN
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5131
Mailing Address - Country:US
Mailing Address - Phone:561-542-3936
Mailing Address - Fax:561-318-5174
Practice Address - Street 1:138 PINEWOOD CT
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8805
Practice Address - Country:US
Practice Address - Phone:561-542-3936
Practice Address - Fax:561-747-1531
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 10469208100000X
FL10469225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ083UOtherBCBS