Provider Demographics
NPI:1033655816
Name:YOUR FOREVER HOME, PLLC
Entity Type:Organization
Organization Name:YOUR FOREVER HOME, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCELLO
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L, CAPS
Authorized Official - Phone:360-621-3341
Mailing Address - Street 1:10855 SILVERDALE WAY NW
Mailing Address - Street 2:UNIT 3175
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7551
Mailing Address - Country:US
Mailing Address - Phone:360-621-3341
Mailing Address - Fax:
Practice Address - Street 1:1581 NE OHARA HILLS DR
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6952
Practice Address - Country:US
Practice Address - Phone:360-621-3341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60066956225XE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental ModificationGroup - Single Specialty