Provider Demographics
NPI:1316213796
Name:PASTORELLA, MARIANNE (CTRS, OTR)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:PASTORELLA
Suffix:
Gender:F
Credentials:CTRS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26200 RED TAIL LN
Mailing Address - Street 2:
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-3436
Mailing Address - Country:US
Mailing Address - Phone:315-796-7304
Mailing Address - Fax:
Practice Address - Street 1:26200 RED TAIL LN
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637-3436
Practice Address - Country:US
Practice Address - Phone:315-796-7304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225X00000X
NY55210225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist