Provider Demographics
NPI:1083760557
Name:CAPPELLETTI, MARA MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARA
Middle Name:MARIE
Last Name:CAPPELLETTI
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 1:4924 HOLLAND CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-9729
Mailing Address - Country:US
Mailing Address - Phone:919-896-2249
Mailing Address - Fax:919-882-8066
Practice Address - Street 1:4924 HOLLAND CHURCH RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-9729
Practice Address - Country:US
Practice Address - Phone:919-896-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4734225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301680Medicaid