Healthcare Provider Details

I. General information

NPI: 1235682543
Provider Name (Legal Business Name): MARCELLA M PELKEY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCELLA M PELKEY OT

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 RICHARDSON ST
NORTHFIELD VT
05663-5644
US

IV. Provider business mailing address

67 ASHFORD LN
WATERBURY VT
05676-9085
US

V. Phone/Fax

Practice location:
  • Phone: 802-485-3161
  • Fax:
Mailing address:
  • Phone: 802-338-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number072.0000523
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: