Provider Demographics
NPI:1427061050
Name:ROTKO, MARILYN (MA, NCMMT, NCTMB)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:ROTKO
Suffix:
Gender:F
Credentials:MA, NCMMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26711 WOODWARD AVE
Mailing Address - Street 2:SUITE LL4
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1333
Mailing Address - Country:US
Mailing Address - Phone:248-542-3390
Mailing Address - Fax:248-542-7659
Practice Address - Street 1:26711 WOODWARD AVE
Practice Address - Street 2:SUITE LL4
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1333
Practice Address - Country:US
Practice Address - Phone:248-542-3390
Practice Address - Fax:248-542-7659
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist