Provider Demographics
NPI:1124604376
Name:ARELLANO, MARISOL (COTA/L)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:ARELLANO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5418 GOLDEN CT
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-8558
Mailing Address - Country:US
Mailing Address - Phone:434-270-2220
Mailing Address - Fax:
Practice Address - Street 1:1 AUTUMN CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:VA
Practice Address - Zip Code:22727-3028
Practice Address - Country:US
Practice Address - Phone:844-334-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000959224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant