Provider Demographics
NPI:1467118646
Name:MARCELLA, CHRISSIE
Entity Type:Individual
Prefix:MRS
First Name:CHRISSIE
Middle Name:
Last Name:MARCELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9913 GREYWELL TERRACE
Mailing Address - Street 2:
Mailing Address - City:MIDLIOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112
Mailing Address - Country:US
Mailing Address - Phone:757-839-9800
Mailing Address - Fax:
Practice Address - Street 1:9913 GREYWELL TER
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3676
Practice Address - Country:US
Practice Address - Phone:757-839-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001116224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant