Provider Demographics
NPI:1578814646
Name:MARSHALL, ZELDA O'DETTE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ZELDA
Middle Name:O'DETTE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BLOCK TER
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-6012
Mailing Address - Country:US
Mailing Address - Phone:516-652-2668
Mailing Address - Fax:
Practice Address - Street 1:2 BLOCK TER
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-6012
Practice Address - Country:US
Practice Address - Phone:516-652-2668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist