Healthcare Provider Details

I. General information

NPI: 1891823035
Provider Name (Legal Business Name): MICHELLE MARCIAL MS OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE LEVEL 1 SUITE MU09
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

2200 GELLERT BLVD 6102
SOUTH SAN FRANCISCO CA
94080-5414
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-4972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number9649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: