Provider Demographics
NPI:1164790077
Name:MINGOLELLI, VERONICA MARIA WALSH (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:MARIA WALSH
Last Name:MINGOLELLI
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15701 BOTTLE RUN RD NE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6736
Mailing Address - Country:US
Mailing Address - Phone:301-338-2190
Mailing Address - Fax:
Practice Address - Street 1:15701 BOTTLE RUN RD NE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6736
Practice Address - Country:US
Practice Address - Phone:301-338-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006864L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist