Provider Demographics
NPI:1659546372
Name:CECCI, MARY JANE TERESA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:TERESA
Last Name:CECCI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113-H COUNTRY CLUB ESTATES
Mailing Address - Street 2:
Mailing Address - City:THORNHURST
Mailing Address - State:PA
Mailing Address - Zip Code:18424
Mailing Address - Country:US
Mailing Address - Phone:570-472-3240
Mailing Address - Fax:
Practice Address - Street 1:113H COUNTRY CLUB EST
Practice Address - Street 2:
Practice Address - City:THORNHURST
Practice Address - State:PA
Practice Address - Zip Code:18424-9305
Practice Address - Country:US
Practice Address - Phone:570-472-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002335L225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility