Healthcare Provider Details

I. General information

NPI: 1275168841
Provider Name (Legal Business Name): KARISA ANN MARCELLETTI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 E RIDGE RD
ROCHESTER NY
14621-1718
US

IV. Provider business mailing address

16 MAIN ST
HILTON NY
14468-1211
US

V. Phone/Fax

Practice location:
  • Phone: 585-544-4077
  • Fax: 585-544-4070
Mailing address:
  • Phone: 585-391-0394
  • Fax: 585-392-8126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032049
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: