Provider Demographics
NPI:1689725426
Name:MARQUEZ, LIEZEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:LIEZEL
Middle Name:
Last Name:MARQUEZ
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 1:29 BANBURY WAY
Mailing Address - Street 2:UNIT 1103
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-7410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 BANBURY WAY
Practice Address - Street 2:UNIT 1103
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-7410
Practice Address - Country:US
Practice Address - Phone:845-787-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2009-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009178-1225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist