Provider Demographics
NPI:1922185651
Name:DODSON, MARIANNE W (COTA/L)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:W
Last Name:DODSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 SCHELLSBURG RD
Mailing Address - Street 2:
Mailing Address - City:CLAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16625-8710
Mailing Address - Country:US
Mailing Address - Phone:814-239-8038
Mailing Address - Fax:
Practice Address - Street 1:501 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6410
Practice Address - Country:US
Practice Address - Phone:814-944-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002675L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000023490012Medicaid
PA1000023490012Medicaid