Provider Demographics
NPI:1508094376
Name:FERRELLI, MICHELE JOHN (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:JOHN
Last Name:FERRELLI
Suffix:
Gender:M
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LOBLOLLY CT
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9349
Mailing Address - Country:US
Mailing Address - Phone:781-507-1163
Mailing Address - Fax:
Practice Address - Street 1:205 RATTLESNAKE TRL
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-7639
Practice Address - Country:US
Practice Address - Phone:910-295-1781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6933225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist