Provider Demographics
NPI:1134380462
Name:NEUENBURG, MARILYNN LOIS (OTR)
Entity type:Individual
Prefix:MRS
First Name:MARILYNN
Middle Name:LOIS
Last Name:NEUENBURG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:MARILYNN
Other - Middle Name:LOIS
Other - Last Name:NEUENBURG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1550 SILVEIRA PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4879
Mailing Address - Country:US
Mailing Address - Phone:415-499-1000
Mailing Address - Fax:415-491-1320
Practice Address - Street 1:1550 SILVEIRA PKWY
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4879
Practice Address - Country:US
Practice Address - Phone:415-499-1000
Practice Address - Fax:415-491-1320
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7901225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist