Provider Demographics
NPI:1467835702
Name:CORSELLO, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:CORSELLO
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 1:60 CHAMBERLAIN RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9192
Mailing Address - Country:US
Mailing Address - Phone:207-883-6680
Mailing Address - Fax:207-883-6695
Practice Address - Street 1:60 CHAMBERLAIN RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9192
Practice Address - Country:US
Practice Address - Phone:207-883-6680
Practice Address - Fax:207-883-6695
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2524225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist