Provider Demographics
NPI:1285716662
Name:PETRIN, MARSHA LYNN (OT)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:LYNN
Last Name:PETRIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:MARSHA
Other - Middle Name:LYNN
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:4601 PARK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2290
Mailing Address - Country:US
Mailing Address - Phone:704-323-3611
Mailing Address - Fax:
Practice Address - Street 1:354 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2402
Practice Address - Country:US
Practice Address - Phone:704-262-4181
Practice Address - Fax:704-721-0916
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3394225X00000X
GAOT005817225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ51900AMedicare PIN
NC0397730010Medicare NSC
GAOT005817OtherOT LIC