Provider Demographics
NPI:1821119785
Name:PICOW, MARILYN RICHMAN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:RICHMAN
Last Name:PICOW
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 TWO NOTCH RD #24
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-1613
Mailing Address - Country:US
Mailing Address - Phone:803-736-5540
Mailing Address - Fax:803-699-0951
Practice Address - Street 1:9600 TWO NOTCH RD STE #24
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-1613
Practice Address - Country:US
Practice Address - Phone:803-736-5540
Practice Address - Fax:803-699-0951
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC327225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist