Provider Demographics
NPI:1912294828
Name:WARNER, MARLA K (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:K
Last Name:WARNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10229 OULEOUT RD
Mailing Address - Street 2:
Mailing Address - City:HUBBARDSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13355-1141
Mailing Address - Country:US
Mailing Address - Phone:315-899-6213
Mailing Address - Fax:
Practice Address - Street 1:10229 OULEOUT RD
Practice Address - Street 2:
Practice Address - City:HUBBARDSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13355-1141
Practice Address - Country:US
Practice Address - Phone:315-899-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002912-1251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)