Provider Demographics
NPI:1043755333
Name:CHANDER, MARCELLA S (OTR/L,PTA)
Entity Type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:S
Last Name:CHANDER
Suffix:
Gender:F
Credentials:OTR/L,PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7504 188TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1703
Mailing Address - Country:US
Mailing Address - Phone:917-364-1721
Mailing Address - Fax:
Practice Address - Street 1:7504 188TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1703
Practice Address - Country:US
Practice Address - Phone:917-364-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY66003461225200000X
NY021191225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant