Provider Demographics
NPI:1932551272
Name:BAZELAIS, MARVELINE (OTR)
Entity Type:Individual
Prefix:MS
First Name:MARVELINE
Middle Name:
Last Name:BAZELAIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:MARVELINE
Other - Middle Name:
Other - Last Name:BAZELAIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:8612 AVENUE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5114
Mailing Address - Country:US
Mailing Address - Phone:347-282-7581
Mailing Address - Fax:
Practice Address - Street 1:8612 AVENUE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5114
Practice Address - Country:US
Practice Address - Phone:347-282-7581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist