Provider Demographics
NPI:1427025659
Name:PELLETIER, MARIA T (OTR L CHT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:T
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:OTR L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 NOTRE DAME BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928
Mailing Address - Country:US
Mailing Address - Phone:530-898-9850
Mailing Address - Fax:530-989-9860
Practice Address - Street 1:2000 NOTRE DAME BLVD
Practice Address - Street 2:STE 120
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928
Practice Address - Country:US
Practice Address - Phone:530-898-9850
Practice Address - Fax:530-989-9860
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2971225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02090ZMedicare ID - Type Unspecified