Provider Demographics
NPI:1205064052
Name:BLOCK, MARJORIE P (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:P
Last Name:BLOCK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 SANTA BARBARA ST.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107
Mailing Address - Country:US
Mailing Address - Phone:619-922-6480
Mailing Address - Fax:866-695-4997
Practice Address - Street 1:9606 TIERRA GRANDE ST
Practice Address - Street 2:SUITE # 107
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-6501
Practice Address - Country:US
Practice Address - Phone:619-922-6480
Practice Address - Fax:866-695-4997
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 5033225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics