Provider Demographics
NPI:1053332577
Name:GIANCOLA, MARIANNE LEWIS (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:LEWIS
Last Name:GIANCOLA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7065 SCHULTZ RD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-9501
Mailing Address - Country:US
Mailing Address - Phone:716-695-4938
Mailing Address - Fax:716-695-3928
Practice Address - Street 1:8672 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7502
Practice Address - Country:US
Practice Address - Phone:716-531-4391
Practice Address - Fax:716-695-3928
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2803-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY281481Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPIST