Provider Demographics
NPI:1558763177
Name:PANETTA, MARY LOUISE (OT,RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:PANETTA
Suffix:
Gender:F
Credentials:OT,RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:PANETTA
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT,RN
Mailing Address - Street 1:548 DANBY CT
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-8508
Mailing Address - Country:US
Mailing Address - Phone:831-359-7818
Mailing Address - Fax:
Practice Address - Street 1:25117 SW PARKWAY AVE STE D
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9697
Practice Address - Country:US
Practice Address - Phone:831-359-7818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology