Provider Demographics
NPI:1063527992
Name:WELLMAN, MARIETTA SUE I (COTA/L)
Entity type:Individual
Prefix:
First Name:MARIETTA
Middle Name:SUE
Last Name:WELLMAN
Suffix:I
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MARIETTA
Other - Middle Name:SUE
Other - Last Name:MERRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:21 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-3115
Mailing Address - Country:US
Mailing Address - Phone:740-773-1141
Mailing Address - Fax:
Practice Address - Street 1:17273 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8608
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-1711224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant