Provider Demographics
NPI:1982819306
Name:CHARLOTIN, MARIE LINE (COTA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LINE
Last Name:CHARLOTIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1433
Mailing Address - Country:US
Mailing Address - Phone:516-546-9227
Mailing Address - Fax:516-546-9227
Practice Address - Street 1:855 WESLEY ST
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1433
Practice Address - Country:US
Practice Address - Phone:516-546-9227
Practice Address - Fax:516-546-9227
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004546-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor