Provider Demographics
NPI:1144111717
Name:MENICHELLI, MARIAH (OTR/L)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:MENICHELLI
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 1:393 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-2325
Mailing Address - Country:US
Mailing Address - Phone:570-855-5636
Mailing Address - Fax:
Practice Address - Street 1:115 GATEWAY SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-4403
Practice Address - Country:US
Practice Address - Phone:570-938-4634
Practice Address - Fax:570-763-4374
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019488225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist