Provider Demographics
NPI:1285705087
Name:GATENBY, MARIELLE LOUISE (ATC)
Entity type:Individual
Prefix:MS
First Name:MARIELLE
Middle Name:LOUISE
Last Name:GATENBY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4234 90TH ST
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:MN
Mailing Address - Zip Code:55336-5505
Mailing Address - Country:US
Mailing Address - Phone:952-467-1915
Mailing Address - Fax:
Practice Address - Street 1:406 N FAXON RD
Practice Address - Street 2:
Practice Address - City:NORWOOD YOUNG AMERICA
Practice Address - State:MN
Practice Address - Zip Code:55368-9507
Practice Address - Country:US
Practice Address - Phone:952-467-1915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer