Active NPI
Bruno Marcon
- Pediatric Occupational Therapist
- Newark, DE
National Provider Identifier
1689403461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- U1-0012654
- Practice address
- 630 Churchmans Road
Newark, DE 19702 - Phone
- (302) 544-5055
- NPI assigned
- Jul 30, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | U1-0012654 | DE | Primary |
Addresses
Primary practice location
630 Churchmans Road
Newark, DE 19702
Mailing address
105 Milhollan Drive
Elkton, MD 21921
Phone (443) 553-0781
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| U1-0012654 | DE | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Theraplay, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinic/Center
- West Chester, PA
- NPI 1982032793
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722297600000",
"number": "1689403461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 MILHOLLAN DRIVE",
"city": "ELKTON",
"state": "MD",
"postal_code": "21921",
"telephone_number": "443-553-0781"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 CHURCHMANS ROAD",
"city": "NEWARK",
"state": "DE",
"postal_code": "19702",
"telephone_number": "302-544-5055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARCON",
"first_name": "BRUNO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-07-30",
"last_updated": "2024-07-30",
"certification_date": "2024-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "DE",
"license": "U1-0012654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.