Provider Demographics
NPI:1033945159
Name:MARVEL, BETHANY
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MARVEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CANAL ST 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-4589
Mailing Address - Country:US
Mailing Address - Phone:888-552-6748
Mailing Address - Fax:
Practice Address - Street 1:41063 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-1831
Practice Address - Country:US
Practice Address - Phone:888-855-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT017173225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist