Provider Demographics
NPI:1265651962
Name:WALBORN, MARCI JEAN (OTRL)
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:JEAN
Last Name:WALBORN
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 1:20 COLD SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17053-9424
Mailing Address - Country:US
Mailing Address - Phone:717-957-4373
Mailing Address - Fax:
Practice Address - Street 1:20 COLD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17053-9424
Practice Address - Country:US
Practice Address - Phone:717-443-7091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006496L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019277140003OtherMEDICAL ASSISTANCE NUMBER