Provider Demographics
NPI:1790084440
Name:WILMARTH, MARIANNE (ATC)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:WILMARTH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 PELHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-2710
Mailing Address - Country:US
Mailing Address - Phone:914-712-9211
Mailing Address - Fax:914-712-9212
Practice Address - Street 1:872 PELHAM PKWY
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-2710
Practice Address - Country:US
Practice Address - Phone:914-712-9211
Practice Address - Fax:914-712-9212
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0013122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer