Provider Demographics
NPI:1609900398
Name:HIGGINS, MARION L (OT)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:L
Last Name:HIGGINS
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 1:4460 REDWOOD HWY STE 16-318
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1951
Mailing Address - Country:US
Mailing Address - Phone:415-902-2367
Mailing Address - Fax:415-451-4919
Practice Address - Street 1:750 LAS GALLINAS AVE STE 110
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3431
Practice Address - Country:US
Practice Address - Phone:415-902-2367
Practice Address - Fax:415-451-4919
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4464225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist