Provider Demographics
NPI:1598914707
Name:MARCELLO, JAMIE LEIGH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LEIGH
Last Name:MARCELLO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1304
Mailing Address - Country:US
Mailing Address - Phone:585-426-6130
Mailing Address - Fax:
Practice Address - Street 1:2755 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1304
Practice Address - Country:US
Practice Address - Phone:585-426-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011168225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist