Provider Demographics
NPI:1699082941
Name:MARZO, CHRISTINE (OTR)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MARZO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:COOPER-MARZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:18 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:EAST WILLISTON
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2511
Mailing Address - Country:US
Mailing Address - Phone:516-833-6187
Mailing Address - Fax:
Practice Address - Street 1:18 SHADOW LN
Practice Address - Street 2:
Practice Address - City:EAST WILLISTON
Practice Address - State:NY
Practice Address - Zip Code:11596-2511
Practice Address - Country:US
Practice Address - Phone:516-833-6187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003819225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist