Provider Demographics
NPI:1205069721
Name:MARCEL, DENISE (OTR)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MARCEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W ANN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-1427
Mailing Address - Country:US
Mailing Address - Phone:570-296-1515
Mailing Address - Fax:570-296-5039
Practice Address - Street 1:109 W ANN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1427
Practice Address - Country:US
Practice Address - Phone:570-296-1515
Practice Address - Fax:570-296-5039
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002225-1225X00000X
PAOC005552L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019265010002Medicaid