Provider Demographics
NPI:1578005856
Name:MARZULLO-COOLEEN, KATHRYN (LMT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MARZULLO-COOLEEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4269 SAINT FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1724
Mailing Address - Country:US
Mailing Address - Phone:716-627-3668
Mailing Address - Fax:
Practice Address - Street 1:4269 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1724
Practice Address - Country:US
Practice Address - Phone:716-627-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0007713225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist