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Organization
MIREILLE MARINO LOTR LLC
Active
Organization
MIREILLE MARINO LOTR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEANNE MIREILLE MARINO OTR/L, MA (OWNER)
(504) 250-9553
Entity
Organization
Contact information
Practice address
4247 SUNSET BLVD, HOUSTON, TX 77005-1907
(504) 250-9553
Mailing address
4247 SUNSET BLVD, HOUSTON, TX 77005-1907
(504) 250-9553
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
111682
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114059904
TYPE 1 NPI
LA
05
—
1302686
—
LA
Enumeration date
06/26/2016
Last updated
06/26/2016
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