Healthcare Provider Details

I. General information

NPI: 1609000637
Provider Name (Legal Business Name): MARJORIE RENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 03/24/2026
Certification Date:
Deactivation Date: 11/04/2024
Reactivation Date: 03/24/2026

III. Provider practice location address

8 JOHN ST
SPRING VALLEY NY
10977-5730
US

IV. Provider business mailing address

8 JOHN ST
SPRING VALLEY NY
10977-5730
US

V. Phone/Fax

Practice location:
  • Phone: 845-596-8178
  • Fax:
Mailing address:
  • Phone: 845-596-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number006818
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: