Provider Demographics
NPI:1023592433
Name:DERILUS, MARLINE (COTA/L)
Entity type:Individual
Prefix:
First Name:MARLINE
Middle Name:
Last Name:DERILUS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1972 IRVING AVE APT A
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2042
Mailing Address - Country:US
Mailing Address - Phone:561-254-1009
Mailing Address - Fax:
Practice Address - Street 1:1972 IRVING AVE APT A
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2042
Practice Address - Country:US
Practice Address - Phone:561-254-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA3952224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant