Provider Demographics
NPI:1831253541
Name:PISCITELLI ENDERS, MARIE (ORTL)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:PISCITELLI ENDERS
Suffix:
Gender:F
Credentials:ORTL
Other - Prefix:MISS
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:PISCITELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E DIMOND BLVD
Mailing Address - Street 2:SUITE #12
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515
Mailing Address - Country:US
Mailing Address - Phone:907-341-7722
Mailing Address - Fax:907-341-7763
Practice Address - Street 1:300 E DIMOND BLVD
Practice Address - Street 2:SUITE #12
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515
Practice Address - Country:US
Practice Address - Phone:907-341-7722
Practice Address - Fax:907-341-7763
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK769225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK435414OtherALASKA BUSINESS LIC
AK769OtherALASKA OT LIC
AK769OtherALASKA OT LIC