Provider Demographics
NPI:1629698048
Name:KOCUR, MARIANNE (CTRS)
Entity Type:Individual
Prefix:MISS
First Name:MARIANNE
Middle Name:
Last Name:KOCUR
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 FALLS OF VENICE CIR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3946
Mailing Address - Country:US
Mailing Address - Phone:814-566-0221
Mailing Address - Fax:
Practice Address - Street 1:509 FALLS OF VENICE CIR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3946
Practice Address - Country:US
Practice Address - Phone:814-566-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA58776225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist