Provider Demographics
NPI:1952660516
Name:MARINO, KATHLEEN P
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:MARINO
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:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:MEDINAH
Mailing Address - State:IL
Mailing Address - Zip Code:60157-0164
Mailing Address - Country:US
Mailing Address - Phone:630-973-3152
Mailing Address - Fax:
Practice Address - Street 1:7N340 MEDINAH RD
Practice Address - Street 2:
Practice Address - City:MEDINAH
Practice Address - State:IL
Practice Address - Zip Code:60157-9622
Practice Address - Country:US
Practice Address - Phone:630-973-3152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist