Provider Demographics
NPI:1942506712
Name:MARCELUS, MARJOE
Entity Type:Individual
Prefix:
First Name:MARJOE
Middle Name:
Last Name:MARCELUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 LESTER AVE
Mailing Address - Street 2:APT 204
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1267
Mailing Address - Country:US
Mailing Address - Phone:610-564-5328
Mailing Address - Fax:
Practice Address - Street 1:267 LESTER AVE
Practice Address - Street 2:APT 204
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-1267
Practice Address - Country:US
Practice Address - Phone:610-564-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9269225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist