Provider Demographics
NPI:1407341985
Name:AIELLO, MARREM PENAFLOR (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARREM
Middle Name:PENAFLOR
Last Name:AIELLO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 NW OUTRIGGER LOOP
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-7254
Mailing Address - Country:US
Mailing Address - Phone:224-616-0834
Mailing Address - Fax:
Practice Address - Street 1:785 SE BAYSHORE DR STE 102
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3275
Practice Address - Country:US
Practice Address - Phone:360-279-8323
Practice Address - Fax:360-279-8772
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60857078225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOT60857078OtherWASHINGTON STATE DEPARTMENT OF HEALTH