Provider Demographics
NPI:1699225763
Name:MARUSHIN, TAMMY (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MARUSHIN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-2616
Mailing Address - Country:US
Mailing Address - Phone:570-453-0252
Mailing Address - Fax:570-453-0253
Practice Address - Street 1:1109 W 15TH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-2616
Practice Address - Country:US
Practice Address - Phone:570-453-0252
Practice Address - Fax:570-453-0253
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005094L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist