Provider Demographics
NPI:1134980543
Name:MARQUEZ, ANGELA MARIE (OT-LP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:OT-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2165
Mailing Address - Country:US
Mailing Address - Phone:201-753-0457
Mailing Address - Fax:
Practice Address - Street 1:356 VILLAGE CT
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2165
Practice Address - Country:US
Practice Address - Phone:201-753-0457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program