Provider Demographics
NPI:1104452721
Name:MARQUIS, JOANNE CECILIA (OT)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:CECILIA
Last Name:MARQUIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 COLD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6352
Mailing Address - Country:US
Mailing Address - Phone:813-653-2564
Mailing Address - Fax:
Practice Address - Street 1:3731 COLD CREEK DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6352
Practice Address - Country:US
Practice Address - Phone:813-653-2564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-15
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5662225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist