Provider Demographics
NPI:1659957256
Name:MARINELLO, ANESSA (MSOT OTR)
Entity Type:Individual
Prefix:
First Name:ANESSA
Middle Name:
Last Name:MARINELLO
Suffix:
Gender:F
Credentials:MSOT OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 STEVENSON DR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2724
Mailing Address - Country:US
Mailing Address - Phone:732-761-1186
Mailing Address - Fax:
Practice Address - Street 1:100 CRAIG RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8787
Practice Address - Country:US
Practice Address - Phone:731-761-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00962400225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001015994OtherUNITED HEALTH CARE