Provider Demographics
NPI:1487787032
Name:MARINO, CHRISTY NEIGHT (LOTR)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:NEIGHT
Last Name:MARINO
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 GOLDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4212
Mailing Address - Country:US
Mailing Address - Phone:985-649-3293
Mailing Address - Fax:985-892-0163
Practice Address - Street 1:203 GOLDENWOOD DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4212
Practice Address - Country:US
Practice Address - Phone:985-649-3293
Practice Address - Fax:985-892-0163
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10305225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1-31660-1Medicaid
LAZ10305OtherO.T. LICENSE