Provider Demographics
NPI:1669641767
Name:THOMAS, MARILYNNE (OTR-L)
Entity Type:Individual
Prefix:
First Name:MARILYNNE
Middle Name:
Last Name:THOMAS
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 1:3198 E 83RD PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6418
Mailing Address - Country:US
Mailing Address - Phone:219-945-0100
Mailing Address - Fax:219-940-3369
Practice Address - Street 1:3198 E 83RD PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6418
Practice Address - Country:US
Practice Address - Phone:219-945-0100
Practice Address - Fax:219-940-3369
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000137A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200635030Medicaid