Provider Demographics
NPI:1770981672
Name:GANYARD, MARIE ZURLO (OTR/L)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ZURLO
Last Name:GANYARD
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 1:3417 MEDICI WAY UNIT 3
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-8729
Mailing Address - Country:US
Mailing Address - Phone:703-489-0785
Mailing Address - Fax:
Practice Address - Street 1:3355 MISSION AVE
Practice Address - Street 2:SUITE 123
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1326
Practice Address - Country:US
Practice Address - Phone:760-529-4975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006486174400000X
CA15972225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist