Provider Demographics
NPI:1710406509
Name:HANEY, MARCIE JEAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:JEAN
Last Name:HANEY
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 1:61980 WHISPERING PINES DR
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-8595
Mailing Address - Country:US
Mailing Address - Phone:330-340-2173
Mailing Address - Fax:
Practice Address - Street 1:62222 FRANKFORT RD
Practice Address - Street 2:
Practice Address - City:SALESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43778-9638
Practice Address - Country:US
Practice Address - Phone:740-679-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.005384225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist