Provider Demographics
NPI:1649480203
Name:MARLATT, MARY KATHERINE (COTA)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHERINE
Last Name:MARLATT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2989 FARM TO MARKET 1540
Mailing Address - Street 2:
Mailing Address - City:SANDIA
Mailing Address - State:TX
Mailing Address - Zip Code:78383
Mailing Address - Country:US
Mailing Address - Phone:361-547-9897
Mailing Address - Fax:
Practice Address - Street 1:2989 FARM TO MARKET ROAD 1540
Practice Address - Street 2:-
Practice Address - City:SANDIA
Practice Address - State:TX
Practice Address - Zip Code:78383
Practice Address - Country:US
Practice Address - Phone:361-547-9897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208780224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant