Healthcare Provider Details

I. General information

NPI: 1609004001
Provider Name (Legal Business Name): GERALDINE HEALY MARINI OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S BROADWAY
PENNSVILLE NJ
08070-2038
US

IV. Provider business mailing address

1 CAROLINE CT
PILESGROVE NJ
08098-2741
US

V. Phone/Fax

Practice location:
  • Phone: 856-678-4701
  • Fax: 856-678-4702
Mailing address:
  • Phone: 856-769-4039
  • Fax: 856-769-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR001115
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: