Healthcare Provider Details

I. General information

NPI: 1083240675
Provider Name (Legal Business Name): MARINA MARIAN OAKES PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/19/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11235 OAK LEAF DR APT 804
SILVER SPRING MD
20901-1386
US

IV. Provider business mailing address

11235 OAK LEAF DR APT 804
SILVER SPRING MD
20901-1386
US

V. Phone/Fax

Practice location:
  • Phone: 315-956-9397
  • Fax:
Mailing address:
  • Phone: 315-956-9397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number011736
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA5156
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: