Healthcare Provider Details

I. General information

NPI: 1134380462
Provider Name (Legal Business Name): MARILYNN LOIS NEUENBURG OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARILYNN LOIS NEUENBURG OTR/L

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 SILVEIRA PKWY
SAN RAFAEL CA
94903-4879
US

IV. Provider business mailing address

1550 SILVEIRA PKWY
SAN RAFAEL CA
94903-4879
US

V. Phone/Fax

Practice location:
  • Phone: 415-499-1000
  • Fax: 415-491-1320
Mailing address:
  • Phone: 415-499-1000
  • Fax: 415-491-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: