Provider Demographics
NPI:1932664349
Name:BOTT, MARLENE (MS, OTR)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:BOTT
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:
Other - Last Name:BOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, OTR
Mailing Address - Street 1:2035 LINCOLN HIGHWAY
Mailing Address - Street 2:EDISON SQUARE WEST
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817
Mailing Address - Country:US
Mailing Address - Phone:866-557-8669
Mailing Address - Fax:
Practice Address - Street 1:2035 LINCOLN HIGHWAY
Practice Address - Street 2:EDISON SQUARE WEST
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817
Practice Address - Country:US
Practice Address - Phone:866-557-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00040800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist