Provider Demographics
NPI:1740509041
Name:BADER, MARILYN M (OTR)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:M
Last Name:BADER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 TOWN PUMP CIR
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-9734
Mailing Address - Country:US
Mailing Address - Phone:585-594-8131
Mailing Address - Fax:
Practice Address - Street 1:64 TOWN PUMP CIR
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-9734
Practice Address - Country:US
Practice Address - Phone:585-594-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005944-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist