Provider Demographics
NPI:1235682543
Name:PELKEY, MARCELLA M (OT)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:M
Last Name:PELKEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MARCELLA
Other - Middle Name:M
Other - Last Name:PELKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:67 ASHFORD LN
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-9085
Mailing Address - Country:US
Mailing Address - Phone:802-338-8265
Mailing Address - Fax:
Practice Address - Street 1:71 RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663-5644
Practice Address - Country:US
Practice Address - Phone:802-485-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072.0000523225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist