Provider Demographics
NPI:1730297292
Name:MARCELLINO, ROXANNE EILEEN (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:EILEEN
Last Name:MARCELLINO
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MISS
Other - First Name:ROXANNE
Other - Middle Name:EILEEN
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:308 CHARLOTTEVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:NY
Mailing Address - Zip Code:12197
Mailing Address - Country:US
Mailing Address - Phone:607-397-9065
Mailing Address - Fax:
Practice Address - Street 1:131 OPPORTUNITY DRIVE
Practice Address - Street 2:
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157
Practice Address - Country:US
Practice Address - Phone:518-295-8130
Practice Address - Fax:518-295-8969
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00733-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist