Provider Demographics
NPI:1851563589
Name:MARCUM, TONI J (DT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:J
Last Name:MARCUM
Suffix:
Gender:F
Credentials:DT, OTR/L
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:J
Other - Last Name:FRECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:211 E PARK CIR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2130
Mailing Address - Country:US
Mailing Address - Phone:773-544-9928
Mailing Address - Fax:815-531-0043
Practice Address - Street 1:211 E PARK CIR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2130
Practice Address - Country:US
Practice Address - Phone:773-544-9928
Practice Address - Fax:815-531-0043
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
IL056010582225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist