Provider Demographics
NPI:1871865915
Name:MARSHALL, MARIAN MARGARETTA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:MARGARETTA
Last Name:MARSHALL
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 1:15 DOGWOOD HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1707
Mailing Address - Country:US
Mailing Address - Phone:631-928-8289
Mailing Address - Fax:631-331-8024
Practice Address - Street 1:15 DOGWOOD HOLLOW LN
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1707
Practice Address - Country:US
Practice Address - Phone:631-928-8289
Practice Address - Fax:631-331-8024
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003519-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics