Provider Demographics
NPI:1174837165
Name:CANTELLO, CAROL M (OTR/L SR FELLOW BC/A)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:CANTELLO
Suffix:
Gender:F
Credentials:OTR/L SR FELLOW BC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12676 COBBLESTONE CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112
Mailing Address - Country:US
Mailing Address - Phone:571-215-3172
Mailing Address - Fax:703-794-7157
Practice Address - Street 1:12676 COBBLESTONE CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112
Practice Address - Country:US
Practice Address - Phone:571-215-3172
Practice Address - Fax:703-794-7157
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003872225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist