Provider Demographics
NPI:1750778700
Name:MAZZARELLI, MICHELLE G (MS,OTR/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:G
Last Name:MAZZARELLI
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3925
Mailing Address - Country:US
Mailing Address - Phone:603-893-2900
Mailing Address - Fax:603-893-9625
Practice Address - Street 1:1230 BRIDGE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01850
Practice Address - Country:US
Practice Address - Phone:978-955-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2439225X00000X
MA10783225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist