Provider Demographics
NPI:1639298300
Name:MURDOCK, MARIANNE T (COTA)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:T
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:T
Other - Last Name:MURDOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:461 SUGARBUSH CIR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-1080
Mailing Address - Country:US
Mailing Address - Phone:330-220-7435
Mailing Address - Fax:
Practice Address - Street 1:461 SUGARBUSH CIR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-1080
Practice Address - Country:US
Practice Address - Phone:330-220-7435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-2833224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant