Healthcare Provider Details

I. General information

NPI: 1215138706
Provider Name (Legal Business Name): MICHELE GIARROCCO OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MEADOW ST
BETHLEHEM NH
03574-4921
US

IV. Provider business mailing address

128 MEADOW ST
BETHLEHEM NH
03574-4921
US

V. Phone/Fax

Practice location:
  • Phone: 603-616-9767
  • Fax:
Mailing address:
  • Phone: 603-616-9767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1179
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: