MEDICARE: MISS MARIANNE KOCUR CTRS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225800000X	Recreation Therapist	58776	PA

General Provider Information

NPI Number	:	1629698048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIANNE KOCUR CTRS

Provider Business Mailing Address
First Line	:	509 FALLS OF VENICE CIR
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-3946
Country	:	US
Telephone Number	:	814-566-0221
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 FALLS OF VENICE CIR
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-3946
Country	:	US
Telephone Number	:	814-566-0221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2020
Last Update Date	:	04/26/2020

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