Provider Demographics
NPI:1326479692
Name:MARESCA, KERI ANN (ATC, CSCS)
Entity Type:Individual
Prefix:MS
First Name:KERI
Middle Name:ANN
Last Name:MARESCA
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 LAWRENCE DR
Mailing Address - Street 2:APT 416
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3644
Mailing Address - Country:US
Mailing Address - Phone:914-645-5828
Mailing Address - Fax:
Practice Address - Street 1:52 LAWRENCE DR
Practice Address - Street 2:APT 416
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3644
Practice Address - Country:US
Practice Address - Phone:914-645-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer