Provider Demographics
NPI:1215050612
Name:MARINO, ARTHUR BASIL (OTR)
Entity type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:BASIL
Last Name:MARINO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40965 E COUNTY ROAD 1240
Mailing Address - Street 2:
Mailing Address - City:KEOTA
Mailing Address - State:OK
Mailing Address - Zip Code:74941-6443
Mailing Address - Country:US
Mailing Address - Phone:018-966-2140
Mailing Address - Fax:
Practice Address - Street 1:1801 S 74TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2814
Practice Address - Country:US
Practice Address - Phone:479-452-9461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR691225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist