Provider Demographics
NPI:1669707816
Name:MARCHETTI, MARILENA DORELLE (MS)
Entity type:Individual
Prefix:MISS
First Name:MARILENA
Middle Name:DORELLE
Last Name:MARCHETTI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 DAY ST
Mailing Address - Street 2:APT. 202
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2942
Mailing Address - Country:US
Mailing Address - Phone:773-729-0914
Mailing Address - Fax:
Practice Address - Street 1:1640 N WELLS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6087
Practice Address - Country:US
Practice Address - Phone:312-642-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist