Provider Demographics
NPI:1134393705
Name:MARCANO, MARIA LUISA (OTRL)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:LUISA
Last Name:MARCANO
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RIVER RD APT A7
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603
Mailing Address - Country:US
Mailing Address - Phone:201-342-2529
Mailing Address - Fax:
Practice Address - Street 1:600 SOUTH LIVINGSTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:800-530-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00101500225X00000X
NY0083771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist