Provider Demographics
NPI:1811305519
Name:DRACHT, MARILYN CORRINE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:CORRINE
Last Name:DRACHT
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 1:3152 PORT SHELDON ST STE A
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9297
Mailing Address - Country:US
Mailing Address - Phone:616-662-0090
Mailing Address - Fax:616-662-0992
Practice Address - Street 1:3152 PORT SHELDON ST STE A
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-9297
Practice Address - Country:US
Practice Address - Phone:616-662-0090
Practice Address - Fax:616-662-0992
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000561225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist