Provider Demographics
NPI:1396961074
Name:VENTRELLA, MARGARET MARY (OTR-L)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:VENTRELLA
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 1:75 YELLOW RUN RD
Mailing Address - Street 2:
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229-2704
Mailing Address - Country:US
Mailing Address - Phone:570-325-5018
Mailing Address - Fax:570-325-8687
Practice Address - Street 1:773 SAINT JOHNS RD
Practice Address - Street 2:
Practice Address - City:DRUMS
Practice Address - State:PA
Practice Address - Zip Code:18222-1803
Practice Address - Country:US
Practice Address - Phone:570-788-8320
Practice Address - Fax:570-788-8321
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006982L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010737390003Medicaid